Pediatric Head & Neck Free-Flap Reconstruction Outcomes: Score-Based Effectiveness Assessment

<b>Background:</b> 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. <b>Methods:</b> Recipient- and donor-site outcomes, swallowing, mastication, breathing, and mouth opening were systematically assessed, and age was analyzed as a modifying variable. <b>Results:</b> 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. <b>Conclusions:</b> 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.