Repair of foot and malleolus defects with deep inferior epigastric perforator flap in children

Objective To discuss the feasibility and the preliminary clinical effect of deep inferior epigastric perforator (DIEP) flap in repair of foot and malleolus defects in child.Methods From August 2003 to October 2006,18 child patients with foot and malleolus defects were treated with DIEP flap.There were 10 males and 8 females,at age range of 3-7 years (average 4.6 years).The defects were on the left joints in 13 patients and on the right in five.All soft tissue defects were caused by traffic accidents that resulted in exposure of the tendons and skeleton.The size of the defect ranged from 11 cm ×6 cmto 17 cm ×6 cm.The minimum DIEP flap in size was 12 cm ×7 cm.The maximum DIEP flap in size was 18 cm × 7 cm.The inferior epigastric artery ( vein) was sutured to the anterior tibial artery (vein) in nine patients,the inferior epigastric artery ( vein) to the dorsal artery (vein) of foot in four and the inferior epigastric artery (vein) to the posterior tibial artery (vein) in five.The donor site of the DIEP flaps was always closed primarily.Results All DIEP flaps survived well in all patients,with primary healing of donor site and receptor site.The follow-up for mean 10.3 months (3-20 months) showed that all flaps survived with excellent color,quality and shape.Thirteen patients regained a protective sensation ,obtained good function of foot and malleolus and resumed the abdomen contour and the abdominal wall competency.There was no abdominal weakness or hernia occurred in the donor sites.Conclusions DIEP flaps are ideal for foot and malleolus reconstruction in child patients,for they can not only preserve the advantages of the traditional transverse rectus abdominis flaps,retain the maximal function of the rectus abdominal muscle and prevent the occurrence of abdominal weakness and hernia,but also avoid second stage reshaping because of its thinness in nature. Key words: Surgical flaps ;  Children ;  Foot injuries ;  Ankle injuries ;