LI Ze , ZHANG Wei , YANG Fei , ZHANG Weidong , CHEN Lan , LIU Feng , LIU Shuhua , XIE Weiguo
  • Department of Burns, Tongren Hospital of Wuhan University&Wuhan Third Hospital, WuHan Hubei, 430060, P. R. China;
ZHANG Wei, Email: zhw010@163.com
Free paraumbilical perforator flaps; soft tissue defect; wound repair; children
10.7507/1002-1892.202503130
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Objective  To explore theeffectiveness of free paraumbilical perforator flaps in repairing skin and soft tissue defects in children. Methods  Between February 2018 and March 2024, 12 children with skin and soft tissue defects were treated with the free paraumbilical perforator flaps. There were 7 boys and 5 girls with an average age of 6.3 years (range, 2-12 years). The defects were located on the upper limbs in 6 cases, lower limbs in 5 cases, and neck in 1 case. The causes of wounds included 7 cases of electrical burns, 1 case of burn, 2 cases of scar release and excision due to scar contraction after burns, 1 case of scar excision due to scar ulcer at the amputation stump after severe burns, and 1 case of skin necrosis after a traffic accident injury. The size of defects after debridement ranged from 7.0 cm×4.0 cm to 18.0 cm×10.0 cm. According to the defect size, 11 cases were repaired with unilateral paraumbilical perforator flaps centered on the umbilicus, among which 3 cases with larger defects were designed as "L"-shaped flaps along the lateral and lower ends of the perforator; the donor sites were directly closed. One case with extensive defect after scar excision and release was repaired with bilateral expanded paraumbilical perforator flaps; the donor sites were repaired with autologous split-thickness skin grafts. The size of flaps ranged from 9.0 cm×4.0 cm to 20.0 cm×11.0 cm. Postoperatively, analgesia and sedation were provided, and the blood supply of the flaps was closely observed. Results  All operations were successfully completed. 6he operation time was 4 to 7 hours, with an average of 5.0 hours. After postoperative analgesia and sedation, the visual analogue scale (VAS) score for pain in all children was ≤ 3, and there was no non-cooperation due to pain. All flaps and skin grafts survived completely, and the wounds healed by the first intention. Ten children underwent 0 to 4 times of flap de-fatting, finger separation, and trimming. All children were followed up 6-48 months (mean, 26 .6months). No obvious swelling of the flaps occurred, and the texture was soft. At last follow-up, among the 6 children with upper limb defects, 4 had upper limb function grade IV and 2 had upper limb function grade V according to the Carroll upper limb function assessment method. The 4 children with lower limb defects had no limitation of joint movement. The neck flexion and rotation in the 1 child with neck defect was significantly improved compared with that before operation. The 1 child with residual ulcer at the amputation stump could wear a prosthesis and move without limitation, and no new ulcers occurred. Linear scars were left at the donor sites, and no abdominal wall hernia was formed. Conclusion The free umbilical perforator flap has abundant blood supply and can be harvested in large size. It can be used to repair skin and soft tissue defects in children and has the advantages of short operation time, minimal injury, high safety, and minimal impact on the growth and development of children.

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