Background: Microsurgical free-flap reconstruction has become essential for restoring form and function in pediatric head and neck defects, yet outcome data remain heterogeneous and often limited to technical survival. This single-center retrospective study evaluated 54 free-flap procedures performed in 46 pediatric patients (16 months–18 years) to assess clinical effectiveness using a standardized Treatment Effectiveness Score integrating flap viability, donor-site healing, and functional recovery. Methods: Recipient- and donor-site outcomes, swallowing, mastication, breathing, and mouth opening were systematically assessed, and age was analyzed as a modifying variable. Results: Overall flap survival reached 76% and mean Treatment Effectiveness Score in cases without flap loss was 89.7. Partial complications occurred in 37% of procedures, while donor-site morbidity was rare (5.6%). Full functional restoration across all domains was achieved in 80.4% of patients, with most impairments occurring in combined osseous and soft-tissue reconstructions. Age demonstrated no significant association with either flap survival or overall treatment effectiveness. Continuous postoperative Doppler monitoring facilitated early identification of vascular compromise and supported salvage attempts in selected cases. Conclusions: These findings support the safety and feasibility of pediatric microsurgical reconstruction across the age spectrum and demonstrate that composite outcome scoring provides a more comprehensive assessment than flap survival alone, offering a framework for standardized reporting in future studies.

Background: Pediatric mandibular reconstruction requires restoration of mandibular continuity while accounting for craniofacial growth, dental development, and long-term functional outcomes. Although vascularized osseous free flaps are widely used, the influence of defect characteristics and patient age on donor-site selection remains unclear. This study evaluated patterns of flap selection in relation to mandibular defect classification and patient age. Methods: This retrospective single-center cohort study included 75 patients aged 1–18 years who underwent microvascular mandibular reconstruction between 2011 and 2025. Donor sites included the fibula, iliac crest, and medial femoral condyle. Mandibular defects were classified according to the Brown classification. Associations between defect class, age, donor-site selection, and flap loss were analyzed. Results: The fibula flap was used most frequently (52.0%), followed by the iliac crest (44.0%) and medial femoral condyle (4.0%). Donor-site selection was significantly associated with Brown defect classification (p < 0.001). Age differed across donor-site groups, with fibula flaps used more often in younger patients and iliac crest flaps in older patients. However, after stratification by defect class, age-related differences were not statistically significant. Overall flap survival was 93.3%, and age was not associated with total flap loss. Conclusions: Donor-site selection showed a stronger association with defect characteristics than with patient age. Observed age-related patterns likely reflect differences in defect morphology. These findings support the clinical relevance of a defect-oriented framework for pediatric mandibular reconstruction; however, flap selection remains individualized and influenced by multiple patient- and surgeon-related factors.

Background: Reconstruction of maxillary defects in pediatric patients presents unique challenges related to craniofacial growth, functional rehabilitation, and long-term treatment planning. Although microvascular free-flap reconstruction is established in pediatric head and neck surgery, maxilla-specific data remain limited. This study aimed to describe donor-site selection patterns in pediatric maxillary microvascular reconstruction and to explore their relationship with patient age. Methods: This retrospective observational study included pediatric patients (aged 1–18 years) who underwent microvascular free-flap reconstruction of the maxilla between August 2011 and September 2025 at a single tertiary referral center. Clinical variables included age, defect characteristics, reconstruction timing, donor-site, and total flap loss. Donor-site selection patterns were analyzed in relation to patient age using nonparametric statistical methods. Results: Fifty-five patients were included. Overall flap survival was 81.82% (45/55). Donor-site selection demonstrated a significant association with patient age (p < 0.05). Younger children were more frequently reconstructed using soft-tissue flaps, whereas osseous flaps were more commonly used in older children and adolescents. No significant relationship was found between age and defect extent or reconstruction timing. Conclusions: In this single-center experience, pediatric maxillary reconstruction followed an age-adapted pattern, with soft-tissue flaps preferentially used in younger patients and osseous flaps more frequently selected in older children. These findings reflect differences in reconstructive priorities across developmental stages and support individualized planning in pediatric maxillary reconstruction. Age alone was not associated with total flap loss; however, this analysis was limited by the small number of flap loss events.