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

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.

Outcomes of Free Muscle Flaps versus Free Fasciocutaneous Flaps for Lower Limb Reconstruction following Trauma: A Systematic Review and Meta-Analysis

“…To eliminate the inclusion of overlapping study populations, the study with the largest patient population from each of these research groups were included and the other studies excluded. Upon exclusion of these studies, 17 studies remained for inclusion in our review and analysis (Table 1) [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] . Over half of the assessed studies have been published since…”

“…Of the studies which specified, the posterior tibial artery was most frequently utilized (54.7%) 27,32,34,37,[42][43] . Flap size, defect size, time to reconstruction, and operative time did not significantly differ across fasciocutaneous versus muscle flap groups.…”

“…Fifteen studies commented on total flap failure. All but one study reported no significant difference in the rate of total flap failure between flap types [27][28][29][30][31][32][33][34][35][36][37][38][39][42][43] . Broer et al, noted a significant increase in total flap failure of their gracilis muscle free flaps compared to their anterolateral thigh fasciocutaneous free flaps in the end-to-side anastomosis group 27 .…”

“…Sixteen studies reported rates of take-back operations [27][28][29][30][31][32][33][34][35][36][37][38][39][41][42][43] . Fourteen of the sixteen studies did not report a statistically significant difference in the rate of take-back procedures between the two free flap types.…”

Analysis of Readmissions and Reoperations in Pediatric Microvascular Reconstruction

“…Parikh et al reported a 15-year review of 30 pediatric patients undergoing microvascular reconstruction of foot and ankle defects with a 96.7% limb salvage rate. 6 Although their complication rate was 33%, free flap reconstruction still proved to be a durable coverage option. Another 40-patient cohort of posttraumatic lower extremity pediatric reconstruction revealed that despite a 20% complication rate, free flap coverage was safe with reassuring long-term outcomes.…”