Lawnmower injuries in children: lower extremity reconstruction
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Pediatric lawnmower injuries require specialized surgical approaches, differing from adult care due to unique patient anatomy and healing capabilities. This study presents an algorithm for optimal surgical reconstruction in children, emphasizing tailored flap and graft choices.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Reconstructive Surgery
Background:
- Power lawnmower accidents are a significant cause of severe pediatric injuries.
- Optimal surgical management for children differs from adults due to anatomical, physiological, and rehabilitative variations.
Observation:
- Children under 2 may not be candidates for microvascular surgery due to small vessel size.
- Older children often have better outcomes with microvascular flaps than adults.
- Pediatric patients demonstrate resilience to skin graft ulceration, tolerate immobilization, and have faster rehabilitation.
Findings:
- A surgical reconstruction algorithm is proposed, prioritizing split-thickness skin grafts.
- Specific muscle flaps (medial gastrocnemius, soleus) are recommended for different leg segments.
- Microvascular flaps are reserved for extensive lower leg defects, with crossleg fasciocutaneous flaps as alternatives.
Implications:
- The algorithm guides reconstructive choices for pediatric lower extremity injuries.
- Emphasis on local vascularized flaps for foot defects improves outcomes.
- Multidisciplinary collaboration is crucial for achieving excellent functional rehabilitation in pediatric patients.
Abstract:
Power lawnmower accidents are one of the most frequent causes of mutilating injuries in pediatric patients. Guidelines for the optimal surgical management of children differ from adult patients by several key anatomic, physiologic, and rehabilitative features. Small blood vessels in children less than 2 years old may prohibit microvascular surgery. Older children with larger vessels are often better candidates for microvascular flaps than their adult counterparts. Pediatric patients also resist recurrent ulceration of foot skin grafts, tolerate prolonged immobilization, and are rehabilitated more readily than adults. In considering these facts, we outlined an algorithm for surgical reconstruction. Split-thickness skin grafts are generally the first choice for coverage. The medial gastrocnemius is the workhorse of the knee and upper third leg. The soleus provides coverage for the middle third leg; microvascular flaps are used for large lower third leg defects. Crossleg fasciocutaneous flaps are good alternatives when microsurgery is not feasible. When possible, the weight-bearing surface of the foot should be covered with local vascularized sensate flaps; larger defects may require free flaps, crossleg, or gluteal-thigh flaps. Excellent functional rehabilitation has been achieved in our young patients through the combined efforts of the trauma service, plastic and orthopedic surgery, and physical and occupational therapy services.