Do Skin Perforator Flaps Accommodate Foot Growth in Children after Reconstruction?

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Whether or not the flap accommodates growth is unpredictable and remains to be determined. We hypothesized that perforator flaps may accommodate growth after reconstruction in children and evaluated change of the flap after foot and ankle reconstruction.


A retrospective review of 28 children from 2003 to 2015 was performed with children under 14 years of age who had foot and ankle soft tissue defects. The following evaluations were made: (1) comparing flap to foot growth, (2) comparing flap/foot dimension using the photo-anthropometric technique defined as proportionality index (PI), and (3) comparing PI ratio of flap to foot area at intervals (ΔPI). All values were measured and statistically evaluated by Pearson's correlation analysis and paired t-test. Subsequent complications and functional results were also evaluated.


Foot and flap after growth had positive correlation in Pearson's correlation analysis, showing the flap expands as the foot grows. The mean intraoperative and postoperative PI was 0.3 and 0.2475, respectively, with statistical significance (ΔPI; p < 0.01). However, no patient had growth disturbance or functional impairment. There was no correlation between ΔPI and motor power grade or between ΔPI and range of motion (p > 0.01).


The skin perforator flap significantly expands during growth after reconstruction. Although the expansion of the flap to foot may not be a one-to-one ratio, it expands enough not to impair the growth or functional outcome of the foot. Skin perforator flap showed growth as children grow and can be considered as a reliable and feasible option in pediatric reconstructive surgery.

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