Abstract
We report a case of extensive foot degloving injury including the plantar area, which was reconstructed with a free anterolateral thigh flap.
A 9-year-old boy was run over by a car on his way to school on foot, and sustained a degloving injury to his right leg. There was an open right tibial shaft fracture, right toe DIP disarticulation, and a sock-form degloving injury which extended from the distal leg to the toes. With external skeletal fixation, a full-thickness skin graft was performed for the distal leg and dorsal foot using exfoliated skin, and the plantar area was covered by artificial dermis in an emergency operation. Internal fixation of the tibia was performed with Ender nailing two weeks later. After one further week, we performed reconstructive surgery for the plantar area using a contralateral free anterolateral thigh flap. As equinus contracture developed, closed mobilization and external skeletal fixation of the ankle joint in a neutral position were performed four weeks after grafting of the free flap.
The patient became able to walk independently 5 months after initial surgery. At 13 months after surgery, ankle dorsiflexion and plantar flexion were 5 degrees and 60 degrees, respectively, showing a good postoperative course of bone union. Neither ulceration nor dyskeratosis was observed in the plantar area, except for a partial epidermolysis.
A free skin flap is used for extended soft tissue damage, whereas a medial plantar flap is considered to be the first option for reconstruction of the weight-bearing part of the foot sole. An anterolateral thigh flap is also useful, in addition to a latissimus dorsi flap and a scapular flap.
