HJAR Mar/Apr 2023

HEALTHCARE JOURNAL OF ARKANSAS  I  MAR / APR 2023 45 Alexis Tashima, MD Plastic and Reconstructive Surgeon Arkansas Children’s Hospital congenital anomalies can play a role in patients with various diagnoses, includ- ing facial nerve palsy, cleft lip and palate, and hemifacial microsomia. 3 Bilateral or unilateral congenital facial nerve palsy can be reconstructed dynamically using a free gracilis muscle flap. The muscle flap is innervated by either a cross facial nerve graft in a unilateral case or the nerve to masseter or hypoglossal nerve in the case of a bilateral palsy. This reconstruction al- lows the patient to have dynamic motion of the oral commissure and form a smile. Maxillary hypoplasia is common in chil- dren with cleft lip and palate, as the upper jaw does not grow in relation to the lower jaw. In patients with bilateral cleft lip and palate, the premaxillary segment can be diminutive and poorly vascularized. To form a properly sized dental arch in co- ordination with the mandible, some pa- tients require free osteocutaneous fibula flaps, for example, from the fibula bone to replace the small central segment. This procedure provides healthy bone for fu- ture osteointegrated dental implants and assists these patients with speech, eating, and establishing facial harmony. Unique considerations in pediatric patients As technology and microsurgical tech- niques have continued to evolve and im- prove, free tissue transfer has become more commonplace in pediatric recon- struction. Considerations need to be made in pediatric patients to account for growth and a lifetime of use of the reconstructed area. Studies have shown that osteocuta- neous free fibula flaps for mandibular re- construction allow for growth of the man- dible in the area of the vascularized bone free flap. 4,5 It is promising that free tissue transfer not only allows for reconstruction of an immediate defect, but it also creates an environment that supports growth as the child develops. An advantage of free tissue transfer in pediatric patients is the option for single-stage reconstruction rather than requiring staged tissue expansion, staged skin grafting, or pedicled flaps that require subsequent flap division. 6 While these staged procedures are sometimes necessary, limiting the need for further surgeries and accelerating recovery time is an important consideration when forming a treatment plan for children. Additional considerations need to be made to optimize the function and the form of the reconstruction or the aesthetic outcome. This includes the donor site and limiting the long-term morbidity from the tissue used for reconstruction. Conclusion In summary, microvascular free tissue transfer in pediatric patients can be a safe and powerful treatment tool for reconstructing various diagnoses with the ability to provide optimal cosmetic and functional outcomes for children. n REFERENCES 1 Serletti, J.M. “Current trends in pediatric mi- crosurgery.” Clinics in Plastic Surgery 32, no. 1 (January 2005): 45-52, viii. doi: 10.1016/ j.cps.2004.10.002 2 Valentini, V.; Califano, L.; Cassoni, A.; et al. “Max- illo-Mandibular Reconstruction in Pediatric Pa- tients: How To Do It?” Journal of Craniofacial Sur- gery 29, no. 3 (May 2018): 761–766. doi: 10.1097/ SCS.0000000000004380 3 Santamaria, E.; Morales, C.; Taylor, J.A.; et al. “Mandibular microsurgical reconstruction in patients with hemifacial microsomia.” Plastic and Reconstructive Surgery 122, no. 6 (De- cember 2008): 1839-1849. doi: 10.1097/PRS. 0b013e31818cc349 4 Volk, A.S.; Riad, S.S.; Kania, K.; et al. “Quantifying Free Fibula Flap Growth After Pediatric Mandib- ular Reconstruction.” Journal of Craniofacial Sur- gery 31, no. 7 (October 2020): e710 - e714. doi: 10.1097/SCS.0000000000006639 5 Temiz, G.; Bilkay, U.; Tiftikcioglu; et al. “The eval- uation of flap growth and long-term results of pediatric mandible reconstructions using free fibular flaps.” Microsurgery 35, no. 4 (May 2015): 253-261. doi: 10.1002/micr.22334 6 Izadpanah, A.; Moran, S.L; “Pediatric Microsur- gery: A Global Overview.” Clinics in Plastic Sur- gery 44, no. 2 (April 2017): 313-324. doi: 10.1016/ j.cps.2016.12.001 Alexis Tashima, MD, is a plastic and reconstructive surgeon atArkansas Children’s Hospital and assistant professor in the Plastic and Reconstructive Surgery Division at the University of Arkansas for Medical Sciences. She completed an undergraduate degree at the University of California,LosAngeles in the field of psychobiology.She subsequently earned amedical doctorate degree at Pennsylvania State College of Medicine. She stayed in Pennsylvania to complete a six-year plastic surgery residency training programat Pennsylvania StateHersheyMedical Center.Following plastic surgery training, she completed a one-year fellowship at Children’s Healthcare of Atlanta, spe- cializing in pediatric plastic surgery and craniofacial surgery. Tashima treats the wide breadth of plastic surgery needs of pediatric patients. She has a specific inter- est in comprehensive cleft care,complex craniofacial anomalies, orthognathic surgery, andmicrosurgical reconstruction.