title: Free anterolateral thigh flap for reconstruction of car tire injuries of children's feet.
abstract: BACKGROUND
  Grade IV and V car tire injuries occurring in children cause extensive soft tissue defects with exposure or loss of tendons and bone on the dorsum of the foot. Free tissue transfer is indicated for reconstruction of these defects because of the limited local tissue available. We describe our management of high-grade car tire foot injuries in children with free anterolateral thigh flap (ALT).
  
  
  METHODS
  Five pre-school children with car tire injuries (one grade IV and four grade V) were treated with free ALT flap in the last 4 years. The mean age was 4.8 years. In four patients, immediate flap coverage after initial debridement was performed and delayed reconstruction was used as a secondary procedure in one patient.
  
  
  RESULTS
  One of the flaps was re-explored for hematoma evacuation and salvaged. All of the flaps survived completely and there were no donor site complications. None of the flaps required a debulking procedure and custom shoe wear has not been necessary in any of the patients. Minor gait abnormalities were detected in two of the patients.
  
  
  CONCLUSIONS
  With minimal donor site morbidity, long vascular pedicle allowing anastomosis outside of the trauma zone, we believe free ALT flap provides the ideal soft tissue reconstruction for high grade car tire injuries of foot in children. ALT flap can be further thinned to adapt to the defect, contracts less than muscle flaps and contains a vascularized fascia which can be used for extensor tendon reconstruction.
authors.affiliation: Ondokuz Mayis University, Plastic, Reconstructive and Aesthetic Surgery, Kurupelit, Samsun, 55200, Turkey. yenerdemirtas@hotmail.com
authors.forename: Yener
authors.initials: Y
authors.lastname: Demirtas
authors.forename: Tale
authors.initials: T
authors.lastname: Neimetzade
authors.forename: Osman
authors.initials: O
authors.lastname: Kelahmetoglu
authors.forename: Ethem
authors.initials: E
authors.lastname: Guneren
mesh_terms: D001336:Automobiles; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D005260:Female; D018409:Foot Injuries / Q000503:physiopathology / Q000601:surgery*; D005684:Gait / Q000502:physiology; D006085:Graft Survival; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013524:Surgical Flaps