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Paediatric distal fibula reconstruction using a pedicled composite second metatarsal flap: a technical note
Weiguo Hu1, Alexandra Trimaille1, Philine De Vries2
1Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Brest, Boulevard Tanguy Prigent, 29609 Brest cedex, France.
Injury
|August 6, 2015
Summary
A pedicled second metatarsal flap successfully reconstructed a 4-year-old boy's lateral malleolus after a lawnmower injury. This technique promoted bone growth and restored ankle function, offering a viable alternative for pediatric distal fibula reconstruction.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Reconstructive Surgery
Background:
- Distal fibula defects in children pose reconstruction challenges, impacting growth and function.
- Traditional methods like microsurgical fibular epiphyseal transplant carry risks.
- Soft tissue damage often necessitates staged reconstruction for optimal outcomes.
Observation:
- A 4-year-old boy sustained a 5cm distal fibula bone loss and severe soft tissue damage from a lawnmower injury.
- Initial split-thickness skin grafting achieved wound healing, but bone reconstruction was required.
- A pedicled second metatarsal flap, incorporating bone, skin, and muscle, was chosen for reconstruction.
Findings:
- The pedicled second metatarsal flap provided bone replacement and soft tissue coverage, enabling continued bone growth.
- Donor site closure was achieved with direct suture, and no immediate complications were observed.
- Seven-year follow-up revealed excellent growth of the transferred bone and adequate ankle function.
Implications:
- Vascularized chimeric second metatarsal flaps offer a promising alternative for pediatric distal fibula reconstruction.
- This technique may reduce the morbidity associated with traditional microsurgical approaches.
- Successful long-term outcomes support its consideration in complex pediatric limb reconstruction cases.
