Free vs. Local Tissue Transfer and Reconstruction in Pediatric Head and Neck Cancer Patients: A Comparable Complication Outcome Review

Authors

Valeria Mejia, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
Asli Pekcan, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
Melanie Bakovic, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
Raina Kushal Patel, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
Marvee Turk, Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA 90033, USA.
Idean Roohani, Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA 90033, USA.
Pasha Shakoori, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
Mark Urata, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
Jeffrey A. Hammoudeh, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.

Document Type

Journal Article

Publication Date

8-18-2025

Journal

Medicina (Kaunas, Lithuania)

Volume

61

Issue

8

DOI

10.3390/medicina61081477

Keywords

free flap; local flap; microsurgery; osteosarcoma; pediatric head and neck cancer; reconstruction; rhabdomyosarcoma; surgery outcomes; wound complications

Abstract

Background and Objectives: Reconstructive outcomes following head and neck (H&N) cancer resection in pediatric patients remain understudied, particularly regarding the comparative efficacy of free versus local tissue transfer. Materials and Methods: A retrospective review was conducted on pediatric patients undergoing malignant H&N tumor resection at a tertiary center from 2007 to 2024. Patients were stratified by reconstruction type (free vs. local flap), and outcomes assessed included flap failure, wound complications, revision rates, operative time, hospital stay, and 30-day readmission. Results: A total of 41 patients (mean age: 10.6 years) met inclusion criteria; 18 underwent free flaps and 23 received local flaps. Common diagnoses included osteosarcoma (21.9%) and rhabdomyosarcoma (12.2%). Anterolateral thigh (44.4%) and fibula (33.3%) were the most common free flaps; temporalis (21.7%) and pectoralis (13.0%) were common local flaps. Flap survival was high in both groups (94.4% vs. 100%). However, local flaps had significantly higher rates of hardware exposure (34.7% vs. 5.5%, p = 0.025) and wound dehiscence (39.1% vs. 5.5%, p = 0.045). Free flaps were associated with longer operative times (10.3 vs. 6.5 h, p = 0.011) and hospital stays (29.1 vs. 13.9 days, p = 0.036). Conclusions: While both approaches achieved high flap survival, free flaps may offer more durable reconstruction and reduce wound-related complications in complex pediatric H&N oncologic cases.

APA Citation

Mejia, Valeria; Pekcan, Asli; Bakovic, Melanie; Patel, Raina Kushal; Turk, Marvee; Roohani, Idean; Shakoori, Pasha; Urata, Mark; and Hammoudeh, Jeffrey A., "Free vs. Local Tissue Transfer and Reconstruction in Pediatric Head and Neck Cancer Patients: A Comparable Complication Outcome Review" (2025). GW Authored Works. Paper 7744.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7744

Department

School of Medicine and Health Sciences Student Works