Innervated Dorsalis Pedis Advancement Flap for Burn Foot Contractures

Dorsal foot burns in children often result in contractures with hyperextension of the toes and secondary gait disturbances. Skin grafting a wound bed after contracture release can result in early recurrence. Adequate contracture release often requires tenolysis and/or joint releases that may be prohibitive of skin grafting and require flap coverage. Local flaps are often dismissed as inadequate. Free flaps and distraction techniques have both been described as difficult in the pediatric foot. We describe a single-stage V-Y advancement dorsalis pedis (DP) based fasciocutaneous flap technique that releases dorsal foot contractures in children without donor sites by recruiting tissue from the anterior ankle to the dorsal forefoot. DP-based flaps have not been described before in forefoot burn contracture release. The flap is performed on three children (ages 4-9 years) with unilateral dorsal feet contractures. Each child suffered from gait disturbance due to toe hyperextension. Three to four centimeters of advancement was obtained with each child. Contractures involved all toes but were worst in the second toe for all patients. Extensor tenolysis and/or metatarsal joint releases were performed in each case. Surgeries were performed as an outpatient with minimal postoperative pain. Postoperative leg splinting was not performed. All patients' surgical sites healed without complication and with complete correction of contractures. Improved gait was noted postoperatively. The V-Y DP perforator advancement is a safe, effective, and reliable technique for dorsal foot burn contracture release in children without need for donor site or prolonged recovery.