Long-term follow-up of coverage of weight bearing surface of the foot with free muscular flap in a pediatric population

Between 1985 and 1991, 13 muscular free flaps with split thickness skin grafts (10 latissimus dorsi, 2 rectus abdominis, and 1 gracilis) were done in 12 patients to cover the weight bearing surface of the foot. Four open wounds were closed primarily and nine unstable scars were replaced with a free flap. A retrospective analysis shows that over the short term the flaps provided a complete coverage of wounds, with a 100% survival of flaps, and permitted normal weight bearing ambulation starting at 1 month postoperatively. Long‐term results show deep pressure sensation but no light touch sensation. All patients are able to wear normal shoes. Six patients (seven flaps) required further surgery to close subsequent wounds on the flaps: Three hypertrophic scars with recurrent ulcerations needed scar revisions, one child presented a fistula through the flap due to underlying osteomyelitis, and one patient presented a friction wound on the lateral malleolus requiring thinning of the flap. Two flaps presented an area of pressure necrosis through the full thickness of the flap and had to be replaced with another free flap (fasciocutaneous sensate flap) over the heel area. In conclusion, it seems that in the pediatric population, skin‐grafted muscular coverage of the weight bearing surface of the foot is a good alternative, even if more problems with hypertrophic scarring around the grafts have been found than in the adult population. In two cases, the flaps had to be replaced because of pressure necrosis over the calcaneus. Long‐term follow‐up of the sensate fasciocutaneous flaps will be needed to find out if they provide a better alternative for foot coverage. © 1994 Wiley‐Liss, Inc. SUIVI À LONG TERME DU RECOUVREMENT DE LA SURFACE PORTEUSE DU PIED AVEC LAMBEAU MUSCULAIRE LIBRE CHFZ LA POPULATIOMN PÉDIATRIQUE Entre 1985 et 1991, 13 lambeaux musculaires libres avec greffe cutanée d'épaisseur (10 grands dorsaux, 2 grands droits de l'abdomen et 1 gracilis) ont été réalisés chez 12 patients pour recouvirir la surface porteuse du pied. Quatre plaies ont ainsi été remplacées primairement tandis que 9 cicatrices instables ont été remplacés. Une analyse rétrospective démontre à court terme une couverture compléte des plaies, une survie de 100% des lambeaux et une mise en charge normale débutée Progressivement 1 mois aprés la chirurgie A long terme, on retrouve une sensibilité profonde à la pression mais pas de sensibilité superficielle au toucher, Tous les patients portent