Free Anterolateral Thigh Flap for Reconstruction of Car Tire Injuries of Children’s Feet

Background: Grade IV and V car tire injuries occurring inchildren cause extensive soft tissue defects with exposure orloss of tendons and bone on the dorsum of the foot. Freetissue transfer is indicated for reconstruction of these defectsbecause of the limited local tissue available. We describe ourmanagement of high-grade car tire foot injuries in children withfree anterolateral thigh flap (ALT). Materials and Methods: Fivepre-school children with car tire injuries (one grade IV and fourgrade V) were treated with free ALT flap in the last 4 years.The mean age was 4.8 years. In four patients, immediate flapcoverage after initial debridement was performed and delayedreconstruction was used as a secondary procedure in onepatient. Results: One of the flaps was re-explored for hematomaevacuation and salvaged. All of the flaps survived completelyand there were no donor site complications. None of the flapsrequired a debulking procedure and custom shoe wear has notbeen necessary in any of the patients. Minor gait abnormalitieswere detected in two of the patients. Conclusion: With minimaldonor site morbidity, long vascular pedicle allowing anastomosisoutside of the trauma zone, we believe free ALT flap providesthe ideal soft tissue reconstruction for high grade car tireinjuries of foot in children. ALT flap can be further thinned toadapt to the defect, contracts less than muscle flaps and containsa vascularized fascia which can be used for extensor tendonreconstruction.Level of Evidence: IV, Retrospective Case SeriesKey Words: Car Tire Injury; Foot Reconstruction; AnkleReconstruction; Free Flap; Anterolateral Thigh Flap; ThinFlap; Children Injury

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