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. LEVEL OF EVIDENCE: Therapeutic study, level IV.
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. LEVEL OF EVIDENCE: Therapeutic study, level IV.