Free flap reconstruction of foot and ankle defects in pediatric patients: long-term outcome in 91 cases.
BACKGROUND
Free tissue transfer has not been fully adopted as the primary mode of treating foot and ankle defects in potentially indicated patients, partly because of the lack of sizable vessels and the potential in the long term of differential growth in the flap and the recipient site. Also lacking are long-term outcome studies in these growing patients.


METHODS
Between 1989 and 2002, 91 children with 93 foot and ankle defects underwent microsurgical reconstructions. The patients underwent reconstruction with flaps with a cutaneous component or with muscle flaps (skin-grafted).


RESULTS
Fifty-eight defects were reconstructed with cutaneous/musculocutaneous flaps (37 fasciocutaneous and 21 musculocutaneous flaps), and 35 were reconstructed with skin-grafted muscle flaps. Thirteen patients underwent secondary free flap surgery, for a total of 106 flaps used to complete the reconstructions. Twelve cases underwent reexploration, and overall survival was 95.3 percent (101 of 106). Secondary deformities were present in 37.9 percent of skin/musculocutaneous flaps and 58.9 percent of skin-grafted muscle flaps (p = 0.029). More resurfacing procedures were performed in skin-grafted muscle flaps than in skin/musculocutaneous flaps (32.4 percent versus 12.1 percent; p = 0.0386).


CONCLUSIONS
Free tissue transfer in pediatric patients is a viable and reliable option. Skin/musculocutaneous flaps and skin-grafted muscle flaps both had equal survival rates; however, flaps with a skin component required fewer secondary procedures to correct deformities. Whenever a skin component was present, it provided useful tissue during the secondary procedure and minimized complications. For plantar foot reconstructions, skin-grafted muscle flaps demonstrated a higher incidence of trophic ulcers and a higher need for resurfacing procedures than flaps with a skin component. Reconstructions of tendons in the immediate setting led to fewer secondary operations than staged tendon reconstructions.
Lin
Chih-Hung
CH
Trauma Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kweishan, Taoyuan 33333, Taiwan. chihhung@cgmh.org.tw
Mardini
Samir
S
Wei
Fu-Chan
FC
Lin
Yu-Te
YT
Chen
Chien-Tzung
CT
D000293:Adolescent; D016512:Ankle Injuries / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000601:surgery*; D050723:Fractures, Bone / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D007223:Infant; D008297:Male; D008866:Microsurgery; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D017695:Soft Tissue Injuries; D013524:Surgical Flaps / Q000098:blood supply / Q000294:innervation; D016896:Treatment Outcome