Wang Gang, Xu Qingjia, Pei Yantao, Ma Zhihu, Shi Anhao, Zhu Lei
Department of Hand and Foot Surgery, Qilu Hospital of Shandong University, Jinan Shandong, 250000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Aug 15;39(8):1025-1029. doi: 10.7507/1002-1892.202505023.
To investigate the management strategies of external fixation combined with microsurgical techniques for repairing complex foot and ankle wounds in children.
The clinical data of 9 children with complex foot and ankle wounds who met the selection criteria between June 2017 and December 2021 was retrospectively analyzed. There were 6 boys and 3 girls, aged 3-13 years, with an average of 7.4 years. The causes of injury included crush injury in 5 cases and traffic accident injury in 4 cases. The wound size ranged from 6 cm×5 cm to 25 cm×18 cm. The time from injury to surgery ranged from 3 to 8 hours, with an average of 5 hours. All cases underwent staged surgical treatment. Among the 3 cases requiring deformity correction, 2 cases initially underwent free anterolateral thigh flap transplantation for wound coverage and limb salvage, followed by circular external fixation combined with osteotomy to address postoperative limb deformity, while 1 case received osteotomy for tibial fracture realignment prior to local pedicled flap reconstruction. All the 6 cases with non-deformity correction underwent initial external fixation followed by secondary flap reconstruction for wound management. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate the foot and ankle function of children.
All children successfully achieved limb salvage postoperatively. Among the 6 non-deformity correction cases, all flaps survived with satisfactory wound healing and no infection was observed; fractures healed within 2.5-4.5 months, after which external fixators were removed for functional rehabilitation with favorable recovery. One case treated with circular external fixation combined with osteotomy achieved bone union at 4 months postoperatively, followed by fixator removal. One case undergoing osteotomy for tibial fracture realignment showed bone healing at 2.5 months post-correction, with subsequent fixator removal. One patient receiving bone lengthening developed infection at 1 week postoperatively, which was managed with multiple debridements, ultimately achieving bone union at 16 months postoperatively and followed by fixator removal. At last follow-up, all patients demonstrated satisfactory ankle-hindfoot functional recovery, with AOFAS ankle-hindfoot scores ranging from 80 to 90 (mean, 84.2).
The combination of external fixation and microsurgical techniques demonstrates significant advantages in reconstructing complex foot and ankle wounds in children. The synergistic interaction provides both mechanical stability and biological repair, enabling early functional rehabilitation while reducing infection risks.
探讨外固定结合显微外科技术修复儿童复杂足踝部创面的治疗策略。
回顾性分析2017年6月至2021年12月间符合入选标准的9例儿童复杂足踝部创面的临床资料。其中男6例，女3例，年龄3 - 13岁，平均7.4岁。致伤原因包括挤压伤5例，交通事故伤4例。创面大小为6 cm×5 cm至25 cm×18 cm。受伤至手术时间为3 - 8小时，平均5小时。所有病例均行分期手术治疗。在3例需要矫正畸形的病例中，2例最初行游离股前外侧皮瓣移植覆盖创面并挽救肢体，随后行环形外固定结合截骨术矫正术后肢体畸形，另1例在局部带蒂皮瓣重建前行胫骨骨折复位截骨术。6例无需矫正畸形的病例均先行外固定，二期行皮瓣重建处理创面。采用美国矫形足踝协会（AOFAS）踝 - 后足评分评估患儿足踝功能。
所有患儿术后均成功挽救肢体。6例无需矫正畸形的病例中，所有皮瓣均存活，创面愈合良好，无感染发生；骨折在2.5 - 4.5个月内愈合，之后拆除外固定架进行功能康复，恢复良好。1例行环形外固定结合截骨术的病例术后4个月骨愈合，随后拆除固定架。1例行胫骨骨折复位截骨术的病例矫正后2.5个月骨愈合，随后拆除固定架。1例行骨延长术的患者术后1周发生感染，经多次清创处理，最终术后16个月骨愈合，随后拆除固定架。末次随访时，所有患者踝 - 后足功能恢复满意，AOFAS踝 - 后足评分80 - 90分（平均84.2分）。
外固定与显微外科技术相结合在儿童复杂足踝部创面修复中具有显著优势。两者协同作用提供了机械稳定性和生物修复能力，能够实现早期功能康复并降低感染风险。
