Abstract
Background There are a limited number of published studies describing reconstruction with an
anterolateral thigh (ALT) flap following lower extremity injury in pediatric patients.
The aim of this study was to present our experiences with the application of a free
ALT flap not only in the reconstruction of soft tissue defects around the pediatric
foot and ankle but also in patients with bone, tendon, and ligament injuries that
require repair.
Materials and Methods Reconstruction with a free ALT flap was performed in 11 pediatric patients (mean
age, 8.9 years; range, 3–15 years) between November 2010 and February 2013. The modes
of injury were as follows: six traffic accidents, three firearm accidents, one agricultural
machinery accident, and one bicycle chain accident. A retrospective evaluation of
the applied surgical procedures was performed: flap size, perforator type and number,
placement area, site of anastomosis, closure of the donor site, complications, and
flap survival.
Results The mean size of the skin flap was 83.2 mm2 (range, 48–117 mm2). Except for two patients, there were two perforators in the obtained flaps, which
were 75% musculocutaneous and 25% septocutaneous. To strengthen the Achilles tendon
in one patient, the ALT, together with the fascia lata, was raised as a composite
flap. This flap was used as a “sensate flap” in three patients with defects in the
heel area and as a “perforator flap” in seven patients. Anastomosis was performed
in the anterior tibial artery in five patients and in the posterior tibial artery
in six patients. Primary closure was performed for the donor site in all patients.
Due to venous thrombus after 24 hours in one patient, reexploration was performed,
and blood flow was regained with a vein graft. In the same patient, partial necrosis
developed on the lateral edge of the flap; after debridement of the necrotic areas,
closure was performed with a split thickness skin graft. After the ALT flap procedure,
the primary flap survival rate was 90.9%.
Conclusion The free ALT flap could be a safe, reliable, and aesthetically appealing option for
foot/ankle resurfacing in children after traumatic soft tissue loss. The ALT flap
can cover a far greater area and provide the versatility needed to optimize soft-tissue
coverage.
Clinical Question/Level of Evidence Level IV.
Keywords
foot and ankle - free anterolateral thigh flap - pediatric reconstruction - trauma
