Institut de la Main Nantes-Atlantique, Santé Atlantique, Avenue Claude Bernard, Saint-Herblain, France.
Institut de la Main, 22 rue Georges Bizet, Hôpital Necker Enfants Malades, Université Paris Descartes, 149 rue de Sevres, Paris, France.
Pan Afr Med J. 2024 Jul 9;48:91. doi: 10.11604/pamj.2024.48.91.43952. eCollection 2024.
Multi-tissue injuries to the foot are common in the pediatric population. Microsurgical repairs are part of the therapeutic arsenal in pediatric reconstructive surgery. We report the case of a 4-year-old boy involved in a lawnmower accident resulting in complete amputation of the hallux, soft tissue damage, and exposure of the calcaneus and first metatarsal. A combined free flap repair using muscle-sparing latissimus dorsi and serratus anterior was performed. The patient was reviewed at 3 months and 1 year with radio-clinical and podoscopic examination. Weight bearing on the foot and on the flap was completely restored without skin fragility. Aesthetics were assessed using a numerical scale and foot function using the American Orthopaedic Foot and Ankle Society (AOFAS) and Foot and Ankle Outcome Score (FAOS) scores. The results of these scores were good, with a clear improvement at 1 year. Repair of the traumatic foot in children requires a robust surgical strategy to restore function and aesthetics to this complex organ. Our combined free flap of muscle-sparing latissimus dorsi and serratus anterioris are the only ones described in the literature. It appears to be a reliable treatment option, with no morbidity and good functional results.
足部多组织损伤在儿科人群中很常见。显微外科修复是小儿重建外科治疗手段的一部分。我们报告了一例 4 岁男孩，他在割草机事故中导致大脚趾完全截肢，软组织损伤，跟骨和第一跖骨外露。采用保留肌肉的背阔肌和前锯肌联合游离皮瓣修复。术后 3 个月和 1 年进行了放射临床和足印检查。患者完全恢复了足部和皮瓣的负重，且皮肤无脆弱性。使用数字评分评估美学，使用美国矫形足踝协会（AOFAS）和足踝结果评分（FAOS）评估足部功能。这些评分结果良好，1 年后明显改善。修复儿童创伤性足部需要一种强大的手术策略，以恢复这个复杂器官的功能和美观。我们采用的保留肌肉的背阔肌和前锯肌联合游离皮瓣在文献中是唯一有描述的。它似乎是一种可靠的治疗选择，无并发症且功能结果良好。
