Horowitz J H, Nichter L S, Kenney J G, Morgan R F
J Trauma. 1985 Dec;25(12):1138-46. doi: 10.1097/00005373-198512000-00004.
Power lawnmower accidents are one of the most frequent causes of mutilating injuries in pediatric patients. Guidelines for the optimal surgical management of children differ from adult patients by several key anatomic, physiologic, and rehabilitative features. Small blood vessels in children less than 2 years old may prohibit microvascular surgery. Older children with larger vessels are often better candidates for microvascular flaps than their adult counterparts. Pediatric patients also resist recurrent ulceration of foot skin grafts, tolerate prolonged immobilization, and are rehabilitated more readily than adults. In considering these facts, we outlined an algorithm for surgical reconstruction. Split-thickness skin grafts are generally the first choice for coverage. The medial gastrocnemius is the workhorse of the knee and upper third leg. The soleus provides coverage for the middle third leg; microvascular flaps are used for large lower third leg defects. Crossleg fasciocutaneous flaps are good alternatives when microsurgery is not feasible. When possible, the weight-bearing surface of the foot should be covered with local vascularized sensate flaps; larger defects may require free flaps, crossleg, or gluteal-thigh flaps. Excellent functional rehabilitation has been achieved in our young patients through the combined efforts of the trauma service, plastic and orthopedic surgery, and physical and occupational therapy services.
电动割草机事故是导致儿科患者肢体毁损性损伤的最常见原因之一。儿童最佳手术治疗的指导原则在几个关键的解剖学、生理学和康复学特征方面与成人患者有所不同。2岁以下儿童的小血管可能无法进行微血管手术。血管较大的大龄儿童通常比成年患者更适合进行微血管皮瓣移植。儿科患者足部皮肤移植后也较少出现复发性溃疡，能耐受长时间固定，且比成人更容易康复。考虑到这些因素，我们制定了一种手术重建算法。通常首选中厚皮片移植进行覆盖。腓肠内侧肌是膝关节和小腿上三分之一部位的常用皮瓣。比目鱼肌用于覆盖小腿中三分之一部位；微血管皮瓣用于小腿下三分之一的大面积缺损。当显微手术不可行时，交腿筋膜皮瓣是很好的替代方案。只要有可能，足部的负重表面应采用局部带血管的感觉皮瓣覆盖；较大的缺损可能需要游离皮瓣、交腿皮瓣或臀股皮瓣。通过创伤科、整形和矫形外科以及物理和职业治疗服务部门的共同努力，我们的年轻患者获得了出色的功能康复。
