HJAR Mar/Apr 2023

44 MAR / APR 2023 I  HEALTHCARE JOURNAL OF ARKANSAS CHILDREN’S HEALTH tions or skin grafting. Therefore, coverage of these types of defects in a manner that will optimize function and form warrants well-vascularized tissue from a remote site on the body. The type of microvascular free flap performed depends on the loca- tion and size of the wound and the type of tissue needed. Workhorse fasciocutaneous free flaps include the radial forearm for thin, soft tissue defects and the anterolat- eral thigh flap for larger, thicker soft tissue defects. Muscle flaps, including the latissi- mus muscle or the gracilis muscle, can be used for larger defects and can be covered with a split-thickness skin graft. Microsurgical techniques in managing What is microsurgery? Microsurgery is a surgical technique commonly utilized by plastic surgeons that allows for tissue to be transferred fromone part of the body to another while ensuring the transferred tissue has the necessary blood supply to survive. This process in- cludes isolating the blood supply to the tissue desired for transfer and then anas- tomosing the artery and vein to vessels in the recipient site to allow inflow and out- flow from the transferred tissue. Lymphat- ics and nerves can also be transferred with the tissue depending on the situation and goals of the procedure. Free tissue transfer is achieved using specialized instrumenta- COLUMN CHILDREN’S HEALTH tion and a high magnification microscope to visualize and manipulate nerves and blood vessels. The tissue being transferred can include skin and fascia, muscle, or even bone. When is microsurgery used? The need to transfer vascularized tissue can present itself in various situations, in- cluding following a traumatic injury, fol- lowing resection of cancer, or for recon- struction of a congenital anomaly. 1,2 Traumatic injuries resulting in loss of skin and soft tissuewith large defects or ex- posure of bone or hardware are frequently not amenable to local tissue coverage op- The Use of Microsurgery I N PED I ATR I CS