Search

Twenty children are presented after undergoing a distally based superficial sural flap for coverage of defects at the lower leg and foot. The age of the patients was between 1 and 12 years. Fifteen patients had trauma to the lower leg, with eight of them having associated injuries. Three had postburn contracture and two had pressure sore. In 14 cases, the flap was used as a fasciocutaneous flap, whereas in six cases it was used as a fascial flap covered with a skin graft. The flaps were used to cover the defects from the dorsum of the foot distally up to the mid third of tibia proximally. The mean follow-up was for a period of 2 years. Even though free tissue transfer is reliable and safe for the reconstruction of major leg injuries in children, the distally based superficial sural flap has the advantage of being easy to perform, with short operating time, minimal donor side morbidity, and preservation of major arteries of the leg.

Forty children treated with free-tissue transfer for soft-tissue coverage of the dorsum of the foot were studied during a follow-up period that ranged from 3 months to 5 years after surgery. Avulsion injuries to the foot were commonly caused by being struck by a vehicle. In 37 of the 40 cases, radical debridement of all devitalized tissue, reconstruction of avulsed tendons and ligaments, and bone fixation were followed by free-flap cover as a one-stage procedure, and, in three cases, as a secondary procedure. Various flaps were used, and although no definite conclusions can be drawn as to which flap performed best, the newer, thinner type of fasciocutaneous flaps yielded promising results.

Vascularised fibula has been used to treat three patients with skin-bone defects of the foot following severe trauma. Similarity between fibula and metatarsal bone is obvious and makes fibula an ideal choice in the replacement of defects in the first metatarsal. Depending on the size of soft tissue defects, different combinations of fibula-skin transfer were used.