الفهرس 
Regional Anatomy of leg and footOnly 14 pages are availabe for public view
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Abstract
Trauma is one of the main mechanisms of complex wound formation affecting pediatric population. The goal of lower extremity reconstruction is the coverage of defects with open wounds of the leg and foot to give patients a healed wound and to let them resume their life while preventing amputation
The aim of the present study was to clinically evaluate the reliability of free anterolateral thigh flap for reconstruction of distal leg and foot defects in pediatric patients.
This prospective study included 20 patients; 6 patients (30%) were female and 14 patients (70%) were males. The mean age of the studied cases was 8.85 years old (range: 5 - 12 years old). They were recruited and assessed for eligibility from Plastic, Burn and Reconstructive Surgery department of Ain-Shams University Hospitals and Department of Plastic and Reconstructive Surgery at Nasser Institute for Research and Treatment.
Regarding the site and type of defect, the present study revealed that the majority of the defects were affecting the foot in (80%) of the cases including dorsum of the foot, heel or both together while mere distal leg defects were in (20%) of the cases and the majority of defects presented as raw area (60%) followed by contractures (20%). The majority of defects etiology were post traumatic raw area (55%) followed by contractures (20%). Also post traumatic unstable scare were in (15%) of cases while (5%) of cases were post malignant tumor excision.
Regarding the timing of reconstruction, the present study indicated that the reconstruction was delayed in 70% and immediate in 30% of cases.
The present study shows that mean of size of the defects that were covered by ALT flap were 18.7×8.8 cm with standard deviation 4.9×3.5 cm and the smallest defect size was measuring around 12×5 cm and the largest defect size was 15×22 cm denoting the flap capability of covering large defects.
Regarding type of perforator flap among the studied cases, the present study revealed that 15 patients (75%) were myocutaneous, 5 patients (25%) were septal. The present study indicated that 13 patients’ flaps (65%) had one perforator, 5 flaps (25%) had two perforators and 2 flaps (10%) had three perforators.
The present study revealed that the pedicle origin was descending branch in 85% of cases and the mean pedicle length was 9.5 ± 1.91 cm.
Regarding the recipient vessels, the present study indicated that 55% received anterior tibial vessels, 30% received posterior tibial vessels and 15% received dorsalis pedis vessels. Regarding type of anastomosis, the present study indicated that 85% of cases have end to end anastomosis and 10% had anastomosis in a flow through manner
Regarding donor site closure, the present study indicated that 60% of donors have direct site closure and 40% have closure with split thickness skin graft (STSG).
The present study indicated that the mean duration time was 365.50±60.39 minutes ranged between 260 to 480 minutes.
Regarding flap complications, the present study indicated that the flap were totally viable in (95%) of cases and only one patient (5%) had total flap loss. Regarding Recipient site early complications, the present study indicated that two cases (10%) have medial edge dehiscence and one case (5%) raw area after flap loss. Regarding recipient site late complication, the present study found that three patients (15%) showed hypertrophic scar.
The present study revealed that 5 patients (25%) required secondary procedures for flap debulking.
Regarding donor site early complications, the present study revealed that two cases (10%) have wound dehiscence and one patient (5%) has partial graft loss. Regarding donor site late complications, the present study indicated that 4 patients (20%) have hypertrophic scar and one patient (5%) has hyperpigmented scar and 2 patients (10%) have wide scar. The donor site functional outcomes were not affected in all cases as all flaps were fasciocutaneous and the study didn’t include any chimeric flap.
Regarding limb function assessment after reconstruction by free anterolateral thigh flap with the maryland foot score, there were 13 patient (65%) that were excellent mostly were patients who had isolated soft tissue defect or unstable scar without orthopedic problem, 4 patients (20%) were good and 3 patients (15%) were fair because of the associated bone condition and orthopedic problem.
Regarding patients’ satisfaction, the present study revealed that 17 patients (85%) were satisfied while two patients (10%) were partially satisfied and one patient (5%) was dissatisfied.