J Reconstr Microsurg 2021; 37(09): 783-790
DOI: 10.1055/s-0041-1727187
Original Article

Free Flap Reconstruction of Traumatic Pediatric Foot and Ankle Defects: An Analysis of Clinical and Functional Outcomes

1  Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
2  Department of Plastic and Reconstructive Surgery, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, District of Columbia
,
Austin Ha
1  Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
,
Thomas Tung
1  Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
› Author Affiliations

Abstract

Background 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.

Methods 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.

Results Thirty patients undergoing 30 flaps were analyzed. The mean age was 11.9 years (range: 2 to 17 years). Muscle flaps (n = 21, 70%) were more common than fasciocutaneous flaps (n = 9, 30%). Limb salvage with functional ambulation was achieved in 96.7% of patients (n = 29). The complication rate was 33.3% (n = 10), with wound breakdown (n = 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%, p = 0.013). Mean follow-up was 8.5 years.

Conclusion 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.

Note

This study was presented at the Annual Meeting of the American Society for Reconstructive Microsurgery (ASRM) in Fort Lauderdale, Florida, January 11 through January 14, 2020.




Publication History

Received: 18 November 2020

Accepted: 15 February 2021

Publication Date:
14 April 2021 (online)

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