Microvascular tissue transfer in pediatric rabdomyosarcoma of the cheek

Abstract

We report complete resection of a pediatric rabdomyosarcoma of the cheek followed by immediate reconstruction using a free flap in a 2-year-old girl. After chemotherapy and radiotherapy, extirpation was performed for the residual tumor. The extensively damaged skin and subcutaneous tissue of her right cheek were reconstructed using a free scapula flap. The vascular pedicle was anastomosed to the right facial artery and vein. Potential problems with anastomosis due to the usually small calibers of these vessels in children did not eventuate in this patient. First priority was given to the success of the graft, and thus a 7-day sedation was planned for the patient. The patient was sedated starting immediately after surgery. Laryngeal edema due to tracheal intubation occurred on the third day after surgery, but gradually decreased and thus extubation was performed on the 14th day after surgery. The free tissue transfer was successful, but after reviewing this case we consider an appropriate rest period and shorter intubation and sedation preferable after microvasucular tissue transfer to decrease the likelihood of laryngeal edema. Regarding the selection of free flaps in children, donor site morbidity should be taken into consideration more seriously than in adults.