Moving Car-Tire Injuries of the Foot: Reconstruction with Microvascular Free Flaps

Abstract

Moving car-tire injury of the foot is a condition that appears to be a new clinical entity in Istanbul, in which the non-weight-bearing surface of the foot is prone to be injured. Between 1992 and 1995, eight moving car-tire injuries of the foot were managed. Patient age averaged 10.25 years (range: 7 to 21 years). All patients presented with soft-tissue loss combined with extensor tendon and bone lesions. In 6 patients, immediate flap coverage after initial debridement and, in 2 patients, delayed coverage after multiple debridements, were performed. All the flaps survived. Although in all patients, the weight-bearing region was always intact, some had gait-pattern abnormalities due to the bone and soft-tissue injuries. Early removal of all devitalized tissues and closure of the wounds with transfer of healthy tissue have a higher rate of success, lower incidence of infection, require fewer operative procedures, and shorter hospitalizations.

A free anterolateral thigh flap and iliotibial band for reconstruction of soft tissue defects at children's feet and ankles

“…An injury unique to children is foot crush injury, occurring when motor vehicles run over the foot [5,6]. Improperly treated, such injuries can result in considerable disability with severe contracture and scarring.…”

“…Improperly treated, such injuries can result in considerable disability with severe contracture and scarring. The keys to successful reconstruction of acute complex trauma at extremities are early removal of all devitalised tissues, early wound closure, and transfer of healthy tissue to achieve adequate soft tissue coverage [6,7]. Ideally, when tissue is lost, similar tissue should be used for reconstruction.…”

“…Free flaps provide better obliteration of a dead space when soft tissue coverage of an exposed complicated fracture and the foot is required [7]. The dorsum of the foot requires a thin reconstruction in order to allow normal shoe wear, dorsal tendon gliding, and ankle motion [6,29]. One of the major advantages of ALT flaps is the possibility of customised thinning to fit a defect to be repaired.…”

Free Anterolateral Thigh Flap for Reconstruction of Car Tire Injuries of Children's Feet

“…The injury is welldefined and causes a crush-avulsion type of wound resulting from a combination of shearing, compression, burning, and even bursting forces. 1,11 Improperly treated, these injuries can result in a considerable disability from severe contracture and unstable scars (Figure 2A).…”

“…Major gait abnormality was defined as an alteration that grossly affected the gait pattern of either leg. 5,11 Problems regarding shoewear were evaluated by the need for custom made shoes and occurrence of any kind of chafing on the flap caused by the shoe.…”