Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri.
Department of Plastic and Reconstructive Surgery, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, District of Columbia.
J Reconstr Microsurg. 2021 Nov;37(9):783-790. doi: 10.1055/s-0041-1727187. Epub 2021 Apr 14.
Traumatic lower extremity injuries involving the foot and ankle can have devastating consequences and represent a complex reconstructive challenge. To date, there are limited reports on microsurgical reconstruction for foot and ankle defects in children. This study aims to evaluate clinical and functional outcomes of free flaps for pediatric foot and ankle injuries.
This is a retrospective review of patients undergoing free flaps for traumatic foot and ankle defects at a pediatric trauma center between 2000 and 2015. Patients with less than 5-year follow-up were excluded. Demographics, clinical characteristics, and postoperative outcomes were evaluated.
Thirty patients undergoing 30 flaps were analyzed. The mean age was 11.9 years (range: 2 to 17 years). Muscle flaps ( = 21, 70%) were more common than fasciocutaneous flaps ( = 9, 30%). Limb salvage with functional ambulation was achieved in 96.7% of patients ( = 29). The complication rate was 33.3% ( = 10), with wound breakdown ( = 6, 20.0%) as most common feature. There were no significant differences in limb salvage, total or partial flap loss, fracture union, and donor-site complications based on flap type. Fasciocutaneous flaps were more likely to require revision procedures for contour compared with muscle flaps (55.6 vs. 9.5%, = 0.013). Mean follow-up was 8.5 years.
Microsurgical reconstruction of pediatric foot and ankle defects results in high rates of limb salvage. A defect- and patient-centered approach to reconstruction, emphasizing durable coverage and contour, is critical to facilitating ambulation and ensuring favorable long-term functional outcomes.
足部和踝关节的创伤性下肢损伤可能会带来灾难性的后果，并且是一个复杂的重建挑战。迄今为止，有关儿童足部和踝关节缺损的显微重建的报告有限。本研究旨在评估游离皮瓣治疗儿童足部和踝关节损伤的临床和功能结果。
这是对 2000 年至 2015 年间在一家儿科创伤中心接受游离皮瓣治疗创伤性足部和踝关节缺损的患者进行的回顾性研究。排除了随访时间少于 5 年的患者。评估了患者的人口统计学、临床特征和术后结果。
分析了 30 例患者的 30 个皮瓣。平均年龄为 11.9 岁（范围：2 至 17 岁）。肌肉皮瓣（ = 21，70%）比筋膜皮瓣（ = 9，30%）更常见。96.7%的患者（ = 29）实现了保肢和功能性步行。并发症发生率为 33.3%（ = 10），以伤口破裂（ = 6，20.0%）最为常见。根据皮瓣类型，保肢率、总或部分皮瓣丢失、骨折愈合和供区并发症无显著差异。与肌肉皮瓣相比，筋膜皮瓣更有可能需要进行轮廓修整手术（55.6%比 9.5%， = 0.013）。平均随访时间为 8.5 年。
儿童足部和踝关节缺损的显微重建可实现高保肢率。以缺损和患者为中心的重建方法，强调持久覆盖和轮廓，对于促进步行和确保良好的长期功能结果至关重要。
