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

Between 1985 and 1991, 13 muscular free flaps with split thickness ski n grafts (10 latissimus dorsi, 2 rectus abdominis, and 1 gracilis) wer e done in 2 patients to cover the weight bearing surface of the foot. Four open wounds were closed primarily and nine unstable scars were re placed with a free flap. A retrospective analysis shows that over the short term the flaps provided a complete coverage of wounds, with a 10 0% survival of flaps, and permitted normal weight bearinq ambulation s tarting at 1 month postoperatively. Long-term results show deep pressu re sensation but no light touch sensation. All patients are able to we ar normal shoes. Six patients (seven flaps) required further surgery t o close subsequent wounds on the flaps: Three hypertrophic scars with recurrent ulcerations needed scar revisions, one child presented a fis tula through the flap due to underlying osteomyelitis, and one patient presented a friction wound on the lateral malleolus requiring thinnin g of the flap. Two flaps presented an area of pressure necrosis throug h the full thickness of the flap and had to be replaced with another f ree flap (fasciocutaneous sensate flap) over the heel area. In conclus ion, it seems that in the pediatric population, skin-grafted muscular coverage of the weight bearing surface of the foot is a good alternati ve, 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. L ong-term follow-up of the sensate fasciocutaneous flaps will be needed to find out if they provide a better alternative for foot coverage.