Adipofascial sural artery flap for foot and ankle reconstruction in children: for better aesthetic outcome

Abstract

Abstract Background: Wheel spoke injury of the ankle and foot is very common in children and its reconstruction is challenging. Reverse flow sural artery fasciocuta-neous flap is versatile for this area but lead to signi-ficant donor site morbidity. Free tissue transfer is an option in children which needs a micro-vascular exper-tise, expensive equipment and long operating time. Method: Fifteen adipofascial flaps were done for foot and ankle coverage from June 2011 to June 2014 at Mahmood F. 1 Associate Professor, Department of Pediatric Plastic and Reconstructive Surgery, The Children's Hospital and Institute of Child Health, Lahore Khan M.A. 2 Senior Registrar, Department of Pediatric Plastic and Reconstructive Surgery, The Children's Hospital and Institute of Child Health, Lahore Iqbal Y. 3 Senior Registrar, Department of Pediatric Plastic and Reconstructive Surgery, The Children's Hospital and Institute of Child Health, Lahore Khan QD 4 Medical Officer, Department of Pediatric Plastic and Reconstructive Surgery, The Children's Hospital and Institute of Child Health, Lahore CH and ICH Lahore. The efficacy of adipofascial sural artery flap for the coverage of these defects was evalu-ated. Results: Fifteen children presented with defects of foot and ankle, 11 (73%) were male and 4 (27%) were female. Their age ranged from 1 - 13 years. All pati-ents had trauma to the foot due to wheel spoke injury. Flaps were used to cover tendoachilles and malleoli. In one patient there was flap tip necrosis with partial graft loss which healed with dressings. Donor site aesthetic outcome was satisfactory in all cases. Mean follow-up was 1 year. Conclusion: Adipofascial Sural artery flap is quick and safe with wide arc of rotation, minimal donor site morbidity and better aesthetic outcome and it does not sacrifice major extremity vessel. Key Words: Foot and ankle, Reconstruction, Adipo-fascial flap, Donor site morbidity.