Innervated Dorsalis Pedis Advancement Flap for Burn Foot Contractures

Area of Science:

• Plastic Surgery
• Pediatric Orthopedics
• Burn Reconstruction

Background:

• Dorsal foot burn contractures in children commonly lead to toe hyperextension and gait disturbances.
• Skin grafting after contracture release risks early recurrence, often necessitating flap coverage.
• Pediatric foot flap coverage presents unique challenges, with free flaps and distraction techniques being complex.

Purpose of the Study:

• To describe a novel single-stage V-Y advancement dorsalis pedis (DP) based fasciocutaneous flap technique.
• To evaluate the efficacy of this technique in releasing dorsal foot contractures in children.
• To assess the need for donor sites and the recovery period associated with this method.

Main Methods:

• A V-Y advancement DP-based fasciocutaneous flap was performed on three pediatric patients (ages 4-9) with unilateral dorsal foot contractures.
• Procedures included contracture release, extensor tenolysis, and/or metatarsal joint releases.
• Tissue was recruited from the anterior ankle to the dorsal forefoot, avoiding donor sites.

Main Results:

• The V-Y DP flap achieved 3-4 cm of advancement in all patients.
• Complete correction of toe hyperextension contractures and improved gait were observed.
• All surgical sites healed without complications, with minimal postoperative pain and no need for splinting.

Conclusions:

• The V-Y DP perforator advancement flap is a safe and effective single-stage technique for pediatric dorsal foot burn contracture release.
• This method avoids donor sites and lengthy recovery periods, offering a reliable solution.
• The technique successfully addresses contractures and associated gait disturbances in young patients.