Surgical strategy for lower extremity skin and soft tissue defects in children – Case series

Abstract

Introduction. Skin and soft tissue defects in lower extremity are challenging clinical situations that have to be dealt with on an individual basis. Closure technique must be tailored to the wound size, location and etiology, and also to the patient’s characteristics (age, other comorbidities etc.). This paper aims at emphasizing the clinical particularities of lower extremity wound closure in children. Material and methods. We review the clinical data, surgical strategy and operative staging, and also the postoperative outcome of three cases of children (aged between 4 and 9 years old) with skin and soft tissue defects caused by trauma and infection, operated in our department in 2017. Results. The three patients presented with lower leg and anterior foot skin and soft tissue defects, ranging from 5 to 10 cm on the long axis, with deep involvement (including joint exposure in one of them). Etiology was traumatic in two cases, one complicated by infection due to inappropriate initial cure. In the third case, the skin defect was caused by foot celluli-tis that was incised and debrided in another hospital, and was referred to us for closure of the remaining uncovered wound. The surgical approach was to use local flaps and skin grafts, alone or combined, after thorough debridement and removal of all infected and devitalized tissue, combined with systemic antibiotics. Postoperative assessment at 1-2 months showed very good graft take and convenient scar appearance, with no functional impairments and no other complications. Conclusions. Surgical protocol for closing lower extremity skin and soft tissue defects raises technical problems, even in the young patient. However, a careful planning of closure steps and preparation of good quality underlying tissues may ensure fast and satisfactory results for the patient and his/her family, as well as for the treating physician.