Treatment options for soft tissue defects in severe foot trauma in children
| Autor: | Elodie Haraux, François Deroussen, Plancq Marie-Christine, Céline Klein, Richard Gouron |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Nursing (miscellaneous) Soft Tissue Injuries medicine.medical_treatment 030230 surgery Surgical Flaps 03 medical and health sciences 0302 clinical medicine Negative-pressure wound therapy medicine Humans Child Foot Injuries Retrospective Studies 030222 orthopedics business.industry Osteomyelitis Treatment options Soft tissue Infant Skin Transplantation Plastic Surgery Procedures medicine.disease Surgery Treatment Outcome Child Preschool Fundamentals and skills Female business Wound healing Foot (unit) |
| Zdroj: | Journal of wound care. 30(6) |
| ISSN: | 0969-0700 |
| Popis: | Objective: Severe foot trauma in children is a therapeutic challenge, with presence of devitalised and soiled distal tissues. Several reconstruction and covering procedures can be applied, including artificial dermis (AD), negative pressure wound therapy (NPWT), fasciocutaneous flaps and free flaps. Here, we have developed and evaluated an algorithm for treating severe foot injuries with skin defects in children Method: Paediatric cases of severe foot injury treated over a 16-year period were retrospectively reviewed. Characteristics of the injuries, surgical procedures, complications and the modified Kitaoka score (clinical and functional rating score of the ankle and foot) were recorded. Results: A total of 18 children were included. The mean age at the time of injury was four years and 10 months (range: 1–11 years). The mean follow-up period was 6.2 years. Of the children, 13 presented with an amputation (12 partial foot amputations and one whole ankle and foot). The skin defect was combined with tendon exposure in nine cases, and/or bone and cartilage in seven cases, and heel damage in two cases. A flap was implemented in eight cases, of which one failed. NPWT was used in 13 patients (for an average of 21 days) and was combined with AD in six patients. The mean modified Kitaoka score was 68 (range: 55–80). Additional surgery during the follow-up period was required in seven patients (dorsal skin retraction, a thick flap, osteoma, trophic ulcer or ankle deviation). Conclusion: Our algorithm suggests different therapeutic strategies for skin coverage and healing, depending on the size of the lesion and the exposed structures, and seems to offer good results. These procedures should be combined with NPWT to optimise these results (improved healing, reduced infections, decreased skin defects and enhanced granulation tissue) and so should be used more frequently. |
| Databáze: | OpenAIRE |
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