Management of lawnmower injuries to the lower extremity in children and adolescents

Lawnmower-associated trauma remains a substantial source of extremity injur y in the pediatric and adolescent patient populations, producing complex wo unds that require a combined orthopedic and plastic surgical approach. The authors review their experience with 16 patients, 2 to 17 years of age (mea n age, 6.2 years), who were admitted to Duke University Medical Center for lower extremity lawnmower trauma between January 1988 and December 1999. Th e average hospitalization time was 13.5 days, and an average of 2.9 surgica l procedures per patient were performed. Early debridement and bony fixatio n were carried out in all patients; 8 patients sustained traumatic amputati ons. Fifteen of 20 nonamputation fractures involved the foot and were manag ed with either closed reduction or K-wire fixation, Three of five long-bone fractures underwent external fixation. Wound closure was achieved with dir ect closure or skin grafting in the majority of patients. However, five mic rosurgical free flap transfers were required for extensive defect reconstru ction of the foot (N = 4) and knee (N = 1). Adequate immediate debridement, fracture reduction, and early primary or if necessary secondary wound cove rage including microsurgical free tissue transfer to prevent further damage and long-term disability in these type of devastating injuries is recommen ded.