LONG-TERM FOLLOW-UP OF COVERAGE OF WEIGHT-BEARING SURFACE OF THE FOOT WITH FREE MUSCULAR FLAP IN A PEDIATRIC POPULATION

Between 1985 and 1991, 13 muscular free flaps with split thickness skin grafts (10 latissimus dorsi, 2 rectus abdominis, and 1 gracilis) were done in 2 patients to cover the weight bearing surface of the foot. Four open wounds were closed primarily and nine unstable scars were replaced with a free flap. A retrospective analysis shows that over the short term the flaps provided a complete coverage of wounds, with a 100% survival of flaps, and permitted normal weight bearinq ambulation starting at 1 month postoperatively. Long-term results show deep pressure sensation but no light touch sensation. All patients are able to wear normal shoes. Six patients (seven flaps) required further surgery to close subsequent wounds on the flaps: Three hypertrophic scars with recurrent ulcerations needed scar revisions, one child presented a fistula through the flap due to underlying osteomyelitis, and one patient presented a friction wound on the lateral malleolus requiring thinning of the flap. Two flaps presented an area of pressure necrosis through the full thickness of the flap and had to be replaced with another free flap (fasciocutaneous sensate flap) over the heel area. In conclusion, it seems that in the pediatric population, skin-grafted muscular coverage of the weight bearing surface of the foot is a good alternative, even if more problems with hypertrophic scarring around the grafts have been found than in the adult population. In two cases, the flaps had to be replaced because of pressure necrosis over the calcaneus. Long-term follow-up of the sensate fasciocutaneous flaps will be needed to find out if they provide a better alternative for foot coverage.