Reconstruction of foot and ankle defects with a free anterolateral thigh flap in pediatric patients

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.