Reconstruction of pediatric foot and ankle trauma

Although reconstruction of complex distal lower extremity trauma has been studied extensively, the subject has rarely been evaluated in the pediatric population. The authors review their experience with 18 patients ranging from 2 to 18 years of age, who were admitted to the trauma service of the Children's Hospital of the University of Pittsburgh between 1991 and 1999 and required plastic surgery evaluation for the management of foot and ankle injuries. The mechanism of injury included motor vehicle accidents (6), lawnmower injuries (6), gunshot wounds (2), crush injuries (2), burns (1), and complex soft tissue injuries (1). The average hospitalization was 14.3 days, and, on average, 3.1 surgical procedures were required per patient. Most of the cohort required microvascular free tissue transfer (11). One patient was managed conservatively, whereas the remainder underwent surgical reconstruction by primary wound closure (1), skin graft (2), or local flap (3). No patient has required treatment of growth disturbance or late functional problems, and the entire population was ambulatory by their 3-month postoperative evaluation. Despite the severity of these injuries, with reliance on microvascular free tissue transfer, an acceptable outcome can be achieved with preservation of the ability to ambulate.