{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T03:09:38Z","timestamp":1792984178329,"version":"4.5.0"},"reference-count":37,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Traumatic lower extremity injuries involving the foot and ankle can have devastating consequences and represent a complex reconstructive challenge. To date, there are limited reports on microsurgical reconstruction for foot and ankle defects in children. This study aims to evaluate clinical and functional outcomes of free flaps for pediatric foot and ankle injuries.<\/jats:p><jats:p>\n          Methods\u2003This is a retrospective review of patients undergoing free flaps for traumatic foot and ankle defects at a pediatric trauma center between 2000 and 2015. Patients with less than 5-year follow-up were excluded. Demographics, clinical characteristics, and postoperative outcomes were evaluated.<\/jats:p><jats:p>\n          Results\u2003Thirty patients undergoing 30 flaps were analyzed. The mean age was 11.9 years (range: 2 to 17 years). Muscle flaps (n\u2009=\u200921, 70%) were more common than fasciocutaneous flaps (n\u2009=\u20099, 30%). Limb salvage with functional ambulation was achieved in 96.7% of patients (n\u2009=\u200929). The complication rate was 33.3% (n\u2009=\u200910), with wound breakdown (n\u2009=\u20096, 20.0%) as most common feature. There were no significant differences in limb salvage, total or partial flap loss, fracture union, and donor-site complications based on flap type. Fasciocutaneous flaps were more likely to require revision procedures for contour compared with muscle flaps (55.6 vs. 9.5%, p\u2009=\u20090.013). Mean follow-up was 8.5 years.<\/jats:p><jats:p>\n          Conclusion\u2003Microsurgical reconstruction of pediatric foot and ankle defects results in high rates of limb salvage. A defect- and patient-centered approach to reconstruction, emphasizing durable coverage and contour, is critical to facilitating ambulation and ensuring favorable long-term functional outcomes.<\/jats:p>","DOI":"10.1055\/s-0041-1727187","type":"journal-article","created":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T23:37:04Z","timestamp":1618443424000},"page":"783-790","source":"Crossref","is-referenced-by-count":10,"title":["Free Flap Reconstruction of Traumatic Pediatric Foot and Ankle Defects: An Analysis of Clinical and Functional Outcomes"],"prefix":"10.1055","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5621-5009","authenticated-orcid":false,"given":"Rajiv P.","family":"Parikh","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri"},{"name":"Department of Plastic and Reconstructive Surgery, MedStar Washington Hospital Center\/Georgetown University School of Medicine, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin","family":"Ha","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Tung","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,4,14]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1055\/s-0039-1695753","article-title":"Principles of orthoplastic surgery for lower extremity reconstruction: why is this important?","volume":"37","author":"S C Azoury","year":"2021","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"157","DOI":"10.2522\/ptj.20090125","article-title":"Dynamic principles of gait and their clinical implications","volume":"90","author":"A D Kuo","year":"2010","journal-title":"Phys Ther"},{"issue":"07","key":"ref3","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1097\/00006534-199406000-00027","article-title":"From the reconstructive ladder to the reconstructive elevator","volume":"93","author":"L J Gottlieb","year":"1994","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1097\/PRS.0b013e3182a80925","article-title":"Evidence-based medicine: lower extremity acute trauma","volume":"132","author":"G G Hallock","year":"2013","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1097\/PRS.0b013e3181cc9630","article-title":"Longitudinal outcomes and 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Surg"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1097\/01.PRS.0000160698.68234.6C","article-title":"Microvascular free flap reconstruction in pediatric lower extremity trauma: a 10-year review","volume":"115","author":"B Rinker","year":"2005","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"634e","DOI":"10.1097\/PRS.0000000000003725","article-title":"The use of perforator flaps in lower extremity traumatic defect reconstruction in the pediatric population","volume":"140","author":"C Herlin","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/S0007-1226(97)90542-7","article-title":"Free tissue transfer for leg reconstruction in children","volume":"50","author":"Y C Chiang","year":"1997","journal-title":"Br J Plast Surg"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/0007-1226(91)90200-4","article-title":"Microvascular tissue transfer in paediatric patients: analysis of 106 cases","volume":"44","author":"F Canales","year":"1991","journal-title":"Br J Plast Surg"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1097\/PRS.0000000000004124","article-title":"Long-term patient-reported outcomes following free flap lower extremity reconstruction for traumatic injuries","volume":"141","author":"S A Egeler","year":"2018","journal-title":"Plast Reconstr Surg"},{"issue":"08","key":"ref17","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1002\/micr.22177","article-title":"Foot and ankle reconstruction: an experience on the use of 14 different flaps in 226 cases","volume":"33","author":"Y L 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