Pediatric Lower Extremity Lawnmower Injuries Requiring Free Tissue Transfer

Pediatric lower extremity lawnmower injuries are high-energy traumas that often result in severe composite tissue loss and require advanced reconstruction. Compared with other mechanisms of pediatric lower extremity trauma, these injuries have a higher incidence of amputation and complex reconstruction. This case series describes 3 pediatric patients, aged 2.5-10 years, who sustained severe lower extremity lawnmower injuries that were managed with free tissue transfer (FTT). Reconstructions included a tensor fasciae latae perforator flap, a latissimus dorsi myocutaneous flap, and an anterolateral thigh perforator flap. These cases demonstrate the practical importance of early escalation to FTT, judicious reconstructive timing, appropriate flap selection between fasciocutaneous and musculocutaneous options, recognition of the indications and limitations of preoperative vascular imaging, and consideration of the unique perioperative challenges associated with FTT.