ADIPOFASCIAL SURAL ARTERY FLAP FOR FOOT AND ANKLE RECONSTRUCTION IN CHILDREN: FOR BETTER AESTHETIC OUTCOME

Background: Wheel spoke injury of the ankle and foot is very common in children and its reconstruction is challenging. Reverse flow sural artery fasciocutaneous flap is versatile for this area but lead to significant donor site morbidity. Free tissue transfer is an option in children which needs a micro-vascular expertise, expensive equipment and long operating time. Method: Fifteen adipofascial flaps were done for foot and ankle coverage from June 2011 to June 2014 at Medical Officer, Department of Pediatric Plastic and Reconstructive Surgery, The Children’s Hospital and Institute of Child Health, Lahore CH and ICH Lahore. The efficacy of adipofascial sural artery flap for the coverage of these defects was evaluated. Results: Fifteen children presented with defects of foot and ankle, 11 (73%) were male and 4 (27%) were female. Their age ranged from 1 – 13 years. All patients had trauma to the foot due to wheel spoke injury. Flaps were used to cover tendoachilles and malleoli. In one patient there was flap tip necrosis with partial graft loss which healed with dressings. Donor site aesthetic outcome was satisfactory in all cases. Mean follow-up was 1 year. Conclusion: Adipofascial Sural artery flap is quick and safe with wide arc of rotation, minimal donor site morbidity and better aesthetic outcome and it does not sacrifice major extremity vessel.