Ondokuz Mayis University, Plastic, Reconstructive and Aesthetic Surgery, Kurupelit, Samsun, 55200, Turkey.
Foot Ankle Int. 2010 Jan;31(1):47-52. doi: 10.3113/FAI.2010.0047.
Grade IV and V car tire injuries occurring in children cause extensive soft tissue defects with exposure or loss of tendons and bone on the dorsum of the foot. Free tissue transfer is indicated for reconstruction of these defects because of the limited local tissue available. We describe our management of high-grade car tire foot injuries in children with free anterolateral thigh flap (ALT).
Five pre-school children with car tire injuries (one grade IV and four grade V) were treated with free ALT flap in the last 4 years. The mean age was 4.8 years. In four patients, immediate flap coverage after initial debridement was performed and delayed reconstruction was used as a secondary procedure in one patient.
One of the flaps was re-explored for hematoma evacuation and salvaged. All of the flaps survived completely and there were no donor site complications. None of the flaps required a debulking procedure and custom shoe wear has not been necessary in any of the patients. Minor gait abnormalities were detected in two of the patients.
With minimal donor site morbidity, long vascular pedicle allowing anastomosis outside of the trauma zone, we believe free ALT flap provides the ideal soft tissue reconstruction for high grade car tire injuries of foot in children. ALT flap can be further thinned to adapt to the defect, contracts less than muscle flaps and contains a vascularized fascia which can be used for extensor tendon reconstruction.
儿童的 IV 级和 V 级汽车轮胎伤会导致广泛的软组织缺损，伴有足背部的肌腱和骨骼外露或丧失。由于可供使用的局部组织有限，游离组织转移是这些缺损重建的指征。我们描述了使用游离股前外侧皮瓣（ALT）治疗儿童高级别汽车轮胎足伤的处理方法。
在过去 4 年中，我们对 5 例因汽车轮胎伤（1 例 IV 级，4 例 V 级）而接受游离 ALT 皮瓣治疗的学龄前儿童进行了治疗。平均年龄为 4.8 岁。在 4 例患者中，在初次清创后立即进行了皮瓣覆盖，1 例患者采用延迟重建作为二期手术。
有 1 例皮瓣因血肿而再次探查并挽救。所有皮瓣均完全存活，无供区并发症。所有皮瓣均无需行削薄术，且在任何患者中均无需定制鞋。在 2 例患者中检测到轻微的步态异常。
游离 ALT 皮瓣具有最小的供区并发症、血管蒂较长（允许在创伤区外吻合），我们认为它为儿童高级别汽车轮胎足伤提供了理想的软组织重建。ALT 皮瓣可以进一步变薄以适应缺损，比肌肉皮瓣收缩少，并且包含可用于伸肌腱重建的血运筋膜。
