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Microsurgical Foot Reconstruction in Children Affected by Lawn Mower Injury
Sandra Feldler1,2, Sandra Scharfetter3, Lorenz Pisecky1,4
1From the Faculty of Medicine, Johannes Kepler University, Linz, Austria.
Insights
Pediatric foot reconstruction after lawn mower injuries is complex but achievable. Microsurgical techniques enable successful limb salvage, restoring function and mobility in young children.
Area of Science:
- Pediatric Orthopedics
- Microsurgery
- Limb Reconstruction
Background:
- Lawn mower injuries pose significant risks to children's lower extremities, sometimes necessitating complex surgical interventions.
- While most injuries require basic wound care, a subset demands advanced microsurgical and orthopedic reconstruction for limb salvage.
- Challenges in pediatric limb reconstruction include small vessel size, vasospasm, compliance issues, and ongoing growth.
Purpose of the Study:
- To demonstrate the feasibility and success of microsurgical foot reconstruction in a pediatric cohort following traumatic amputation.
- To evaluate the functional outcomes of limb salvage procedures in young children after severe foot injuries.
Main Methods:
- A case series involving three patients under five years old who sustained severe foot injuries from lawn mowers.
- Reconstruction involved microsurgical techniques, including latissimus dorsi and gracilis muscle flaps, alongside orthopedic procedures like tendon transfers.
- Functional outcomes were assessed using the Lower Extremity Functional Scale (LEFS).
Main Results:
- All three pediatric patients underwent successful microsurgical and orthopedic reconstruction with no major complications.
- Reconstructions were performed between 1 to 24 days post-injury in patients aged 2, 3, and 5 years.
- Patients achieved excellent functional outcomes, with LEFS scores of 75-80 out of 80, preserving their ability to walk and participate in sports up to 20 years post-reconstruction.
Conclusions:
- Microsurgical reconstruction is a viable and effective option for limb salvage in pediatric patients with traumatic foot amputations, even at a young age.
- Successful outcomes depend on intricate procedures and interdisciplinary collaboration for comprehensive treatment.
- Restoring optimal functionality and enabling participation in activities is achievable through advanced reconstructive techniques.
Background:
Lawn mower injuries can cause limb-threatening wounds in the lower extremities of children. Although most cases require only basic wound treatment, a minority need microsurgical and orthopedic reconstruction for limb salvage. These procedures remain complex owing to small vessel diameter, increased vasospasticity, limited postoperative compliance, and continued growth in children. This case series demonstrated successful microsurgical foot reconstructions in a selected pediatric patient cohort.
Methods:
Three patients younger than 5 years underwent foot reconstruction after mower injury. Injury patterns included (1) Chopart-like forefoot amputation, (2) first toe amputation, and (3) amputation of metatarsals I and II with destruction of the third toe, each with respective soft tissue defects. One patient required hindfoot reconstruction and tendon transfers before microsurgery. Two patients received latissimus dorsi flaps, and 1 was treated with a gracilis muscle flap. Functional outcomes were assessed using the Lower Extremity Functional Scale.
Results:
Patients were aged 2, 3, and 5 years, with reconstruction performed 1-24 days postinjury. All 3 patients underwent successful microsurgical and orthopedic reconstruction with no major complications. All patients presented with preserved ability to walk and participate in sports, achieving Lower Extremity Functional Scale scores of 75-80 out of 80, even after a maximum follow-up of 20 years.
Conclusions:
Foot reconstructions after traumatic foot amputation in children are intricate procedures. Nonetheless, microvascular reconstruction is a feasible option for limb salvage in pediatric patients even at ages as young as 2 years. Interdisciplinary cooperation is essential to provide a comprehensive treatment concept and restore optimal functionality.
