COMPLEX FOOT TRAUMA IN CHILDREN: MANGEMENT AND CLINICAL COURSE

Abstract

Purpose of the study: Even more so than adults, children are exposed to serious foot trauma caused by lawn mowers, bicycle spokes, or car wheels. These different mechanisms produce specific lesions to the rear foot or the toes and the dorsal aspect of the foot. Each type of lesion raises specific problems concerning emergency cover. Sequelae evolve with growth. We present a series of thirteen children given emergency treatment then long-term care over periods of six months to twenty years.

Material and results: The heel was amputated in four children (lawn mower or bicycle spoke accidents). Cover was obtained with a sural (three first-intention) neurovascular island flap with a distal pedicle. The long-term assessment evaluated function as well as residual growth of the calcaneum. Four lawn mower accidents produced lesions involving the toes and the mediotarsal area which did not require emergency flap cover. Dorsal retractions occurred in all four cases and progressed secondarily, later requiring a good quality skin flap and dorsal release. In five children lesions of the toes, forefoot, or the entire foot occurred in five children whose foot was crushed under car (or truck) wheels or was injured during fall from a wall. In these children, the urgent or secondary skin problems predominated in the dorsal area and required a variety of flaps.

Discussion: «Dorsal trauma» appears to have a predominant effect in children because the toe alignment during growth is directly dependent on the flexibility of the dorsal tissues. Several flaps can be used for this indication but are often difficult to achieve for the more distal areas (commissures and toes). Heel reconstruction is also a difficult challenge with the problem of sensitivity and tissue quality. It does not resolve the problem raised by amputation of the posterior calcaneal growth nucleus.