Management of Complex Avulsion Injuries of the Dorsum of the Foot and Ankle in Pediatric Patients by Using Local Delayed Flaps and Skin Grafts

Objective: Avulsion injuries of the dorsum of the foot and ankle present difficult reconstructive problems especially in pediatric patients. Usually, there is exposure of bones, joints, tendons, or ligaments, which requires coverage by flaps. The best skin for coverage is the local skin, but the remaining intact skin is usually limited. Usage of such local skin necessitates elevation of long and narrow skin flaps. These flaps need delay to survive. Method: This study included 8 children who sustained avulsion injuries to their feet and ankles in road traffic accidents. Debridement and delaying flaps using bipedicled flap elevation technique were done in the first session. Dressing of the raw areas was done while the flaps were being delayed. The delayed flaps were elevated in the second session to cover any exposed bone, joints, or ligaments. Split thickness skin grafts were applied to the donor site and to the granulating raw areas. Results: Complete survival of the flaps and complete take of the skin grafts with minimal donor site morbidity. Conclusion: This technique of delaying flaps from the intact skin adjacent to the defect is safe, successful and allows minimal hospital stay.