Microsurgeon.org

An atlas of microsurgery techniques and principles.


Microsurgery in children

Children represent a focus of the true microsurgical center, because the small structures involved in surgically managing a child are ideally suited to the skills of a microsurgeon. And because the outcomes in children tend to be better than adults, treating children is particularly rewarding to the microsurgeon. The parents of the child are essentially an addition to the microsurgical team, and are at the focus of management along with the child. They are contributors to the team and their needs need to be addressed by team, wether emotional, financial or in terms of logistics and housing during the time of treatment for the child. Often, families need to travel a long distance to pursue microsurgical treatment. This is more easily addressed in elective treatment, but particularly stressful to the family when emergency surgery and treatment after trauma is necessary. And treatment often needs to be facilitated after in-patient hospital care, for instance when physical therapy or home nursing is part of the recommended regimen.

Categories of Pediatric Microsurgery

The diversity of microsurgery and it's applications is reflected in the types of treatments microsurgeons are able to offer children.

Congenital Deficiencies

  • Facial Palsy and Anomalies
  • Hand Anomalies

Traumatic Injuries

  • Facial
  • Hand and Arm
  • Foot and Leg

Cancer Reconstruction

Consultation

When congenital absences are the reason for microsurgical consultation, a careful history and physical examination and review of pertinent records is performed. This can be done in a relaxed environment and appropriate consultations to other caregivers can be obtained. Religious and cultural issues can be addressed if warranted and the treatment and potential outcomes, as well as risks and possible complications can be addressed.

In emergency situations, the parents have different kinds of stress and anxiety, and it is much more difficult to make decisions. Accidents are often not witnessed by parents, and a young child often is unable to give a reliable history and may be unable to describe symptoms. Experience of the microsurgeon and team are critical elements in management in this regard. Many children are transferred from a distance, and treating physicians and nurses are communicated with by phone.

The operative procedure

Pediatric anesthesia and a childrens facility are used, with pediatric nursing and intensive care post-operatively as needed. Because the parents are the key to rehabilitation they are encouraged to be present at all possible times even during induction of anesthesia. After the induction of anesthesia, they are escorted to a waiting area until the procedure is completed and then they are allowed to re-join their child in the recovery room.

Pediatric microsurgical procedures that involve flaps are addressed with two operative teams, to minimize anesthetic time and to enhance the outcome. Success is dependent on experienced and technically skilled microsurgeons. A children's hospital is not necessarily a sign that microsurgeons are experienced or even technically adept. Sometimes the reputation and institutional framework and structure afforded by a known childrens hospital is not indicative of microsurgical skill. A good reputation of a children's hospital does not in any way mean the microsurgeon or microsurgeons are any good.

Post-Operative Care and Rehabilitation

A good relationship between the parent, the physician, and nurses results in the most satisfying outcome. The most involved parents are the best advocates for their children and the best friends of the physicians and nurses. Parents are encouraged to be at the bedside at all times after surgery and with the pediatricians, nurses and surgeons, the are keys to the recovery that begins right after surgery.