Postoperative Care of Pediatric Oncologic Microvascular Flap Surgery

Monday, March 23, 2026

2:30 PM - 3:30 PM Central Time

Location: Connections Central - RST 07

Ali Ahmad, DO, FAAP

MD Anderson Cancer Center

Disclosure(s): No relevant financial relationship(s) to disclose.
GM

Gopi Mohan, MD, PhD

Assistant Professor, Pediatric Critical Care
University of Texas MD Anderson Cancer Center

Disclosure information not submitted.
AA

Ankit Agarwal, MD

Assistant Professor, Pediatric Critical Care
Texas Tech University HSC El Paso

Disclosure information not submitted.
AG

Adrian Gutierrez, MD

Fellow, Pediatric Oncology
University of Texas MD Anderson Cancer Center

Disclosure information not submitted.
CA

Clark Andersen, n/a

Senior Biostatistician
University of Texas MD Anderson Cancer Center

Disclosure information not submitted.
MR

Margaret Roubaud, MD

Associate Professor, Plastic Surgery
University of Texas MD Anderson Cancer Center

Disclosure information not submitted.
MH

Matthew Hansono, MD

Professor, Plastic Surgery
University of Texas MD Anderson Cancer Center

Disclosure information not submitted.
EC

Edward I-Fei Chang, MD

Professor, Plastic Surgery
University of Texas MD Anderson Cancer Center

Disclosure information not submitted.
RM

Rodrigo Mejia, MD, FCCM

Professor, Pediatric Critical Care
University of Texas MD Anderson Cancer Center

Disclosure information not submitted.

Introduction: Advances in surgical oncology have enabled the increasing utilization of aggressive tumor resections in pediatric patients, often requiring complex flap reconstructions to restore form and function. Despite this, there remain limited data describing the postoperative critical care course of these patients. This study aims to characterize the postoperative management and clinical course of pediatric oncology patients who underwent surgical tumor resection with flap reconstruction over a 7-year period.

Methods: We conducted a single-center, retrospective cohort study of patients admitted to the pediatric intensive care unit (PICU) following surgical tumor resection and flap reconstruction between 2016 and 2023. Inclusion criteria were age ≤ 21 years at the time of surgery, confirmed oncologic diagnosis, surgical tumor resection with subsequent flap reconstruction, and postoperative admission to PICU. Electronic medical records (EMR) were reviewed to extract demographic information and clinical data. All data were de-identified and stored securely in compliance with institutional data protection policies. Descriptive statistics were used to summarize baseline characteristics and outcomes. Continuous variables are reported as medians with interquartile ranges (IQR), and categorical variables as counts and percentages. Comparative analyses were conducted based on flap type and need for postoperative support, using chi-square or Fisher’s exact tests for categorical variables and Mann-Whitney U tests for continuous variables.

Results: 97 subjects were included. 31 subjects received a head and neck flap, 4 received a thoracoabdominal flap, and 62 received an extremity flap. Subjects under 40 kg were less likely to receive anticoagulation, (5 vs 42) (p=0.0006). Subjects with head and neck flaps (18) were more likely to develop acute respiratory failure than those with thoracoabdominal (2) or extremity flaps (12) (p=0.0005). Subjects with head and neck flaps were more likely to have tracheostomy (9) than those with thoracoabdominal or extremity flaps (0) (p=0.002).

Conclusions: Understanding the postoperative needs of children recovering from oncologic microvascular flap surgery is essential to optimize outcomes, allocate ICU resources effectively, and inform perioperative care protocols.