Reconstruction of total degloving injuries of the foot in children

BACKGROUND: The aim of this study is to introduce experiences of reconstruction of total degloving injuries of the foot in children. METHODS: Seven children, five male and two female, were treated for total degloving injury of the foot at our medical institution between January 2002 and December 2008. Patients were between 5 years and 9 years of age with a mean age of 7 years. All injuries involved the total foot. In cases 1-3, the foot was covered by intermediate split-thickness skin graft. In cases 4-7, the dorsal aspect of the foot was covered by full-thickness skin graft obtained from the degloving flap in emergency operation and the planta aspect of the foot was covered by posteriortibial artery flap in the second operation. RESULTS: The mean time to wound healing was 29 days to 50 days in cases 1-3 and 21 days to 28 days in cases 4-7. The posteriortibial artery flaps in cases 4-7 all survived. Both the donor and the recipient site healed successfully. All patients were followed for at least 12 months (range, 12-24 months; mean, 17.9 months). All patients showed insensitivity at the recipient sites. No patient complained of cold intolerance in the foot. Cases 1-3 had pain, deformity, and dysfunction to some extent at follow-up. Cases 4-7 did not exhibit pain, deformity, or dysfunction. All toes were amputated in all cases. Patients 1-3 scored fair or poor on the Maryland Foot Score (two fair, one poor), and patients 4-7 scored either good or fair (three good, one fair). CONCLUSION: This method, the dorsal aspect of the foot covered by full-thickness skin and the planta aspect of the foot covered by posteriortibial artery flap, is a good choice for treatment of total degloving injury of foot in children. At the same time, the early exercise should be emphasized for the functional recovery. (J Trauma Acute Care Surg. 2012;73: 209-214. Copyright (C) 2012 by Lippincott Williams & Wilkins) LEVEL OF EVIDENCE: Therapeutic study, level IV.