title: Do Skin Perforator Flaps Accommodate Foot Growth in Children after Reconstruction?
abstract: BackgroundsWhether or not the flap accommodates growth is unpredictable and remains to be determined. We hypothesized that perforator flaps may accommodate growth after reconstruction in children and evaluated change of the flap after foot and ankle reconstruction.MethodsA retrospective review of 28 children from 2003 to 2015 was performed with children under 14 years of age who had foot and ankle soft tissue defects. The following evaluations were made: (1) comparing flap to foot growth, (2) comparing flap/foot dimension using the photo-anthropometric technique defined as proportionality index (PI), and (3) comparing PI ratio of flap to foot area at intervals (ΔPI). All values were measured and statistically evaluated by Pearson's correlation analysis and pairedt-test. Subsequent complications and functional results were also evaluated.ResultFoot and flap after growth had positive correlation in Pearson's correlation analysis, showing the flap expands as the foot grows. The mean intraoperative and postoperative PI was 0.3 and 0.2475, respectively, with statistical significance (ΔPI;p< 0.01). However, no patient had growth disturbance or functional impairment. There was no correlation between ΔPI and motor power grade or between ΔPI and range of motion (p> 0.01).ConclusionThe skin perforator flap significantly expands during growth after reconstruction. Although the expansion of the flap to foot may not be a one-to-one ratio, it expands enough not to impair the growth or functional outcome of the foot. Skin perforator flap showed growth as children grow and can be considered as a reliable and feasible option in pediatric reconstructive surgery.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Sanggye Baek Hospital, Inje University, Seoul, Korea.
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Cho
authors.affiliation: Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan Collage of Medicine, Seoul, Korea.
authors.forename: Hyun Suk
authors.initials: HS
authors.lastname: Suh
authors.affiliation: Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan Collage of Medicine, Seoul, Korea.
authors.forename: Joon Pio
authors.initials: JP
authors.lastname: Hong
mesh_terms: D000293:Adolescent; D000842:Ankle / Q000254:growth & development / Q000601:surgery*; D016512:Ankle Injuries / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005528:Foot / Q000254:growth & development / Q000601:surgery*; D018409:Foot Injuries / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D061525:Perforator Flap / Q000098:blood supply*; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome