原文
因此儿童足踝部的皮肤软组织缺损能够一期修复的最好进行一期修复。即使部分病例在外院无法一期修复，转入后也应争取尽早修复。对于儿童足踝部皮肤软组织缺损的修复方法的选择，要充分考虑其继续生长发育的生理特点。因此不但要覆盖创面，而且尽量要减少供区功能发育的影响。那些可能导致肌肉或大血管功能损害的修复手段要尽量避免使用。既往经常使用的修复方法包括局部带蒂皮瓣，交腿皮瓣和游离皮瓣。交腿皮瓣虽然在成人中应用较为成功，但是对于儿童来说长时间体位不适的固定使它的应用受到限制2,3。对于足踝部较大面积皮肤缺损，有些作者喜欢应用游离皮瓣，并证实了手术的安全性。Yener特别指出股前外侧皮瓣的优点包括皮瓣位于股前外侧，可以允许两个手术组同时开展手术，从而缩短手术时间；可切取的皮瓣面积较大并有较长的血管蒂；在需要的时候皮瓣可包含多种不同的组织；另外供区功能外形损害较轻。但游离移植毕竟有一定风险，而且它复杂的技术需要特殊训练的显微外科医生，特殊的设备也不是随时都可得到的，而且一旦失败会导致皮瓣的全部坏死。这些因素都限制了它在一些医院中在儿童伤后急需一期手术覆盖创面时的应用。
译文
Once soft tissue defects of the foot and ankle in children occurred, first-stage reconstruction was strongly recommended. Concepts believed to be important in the satisfactory reconstruction of complex soft tissues in foot and ankle region included early removal of all devitalized tissues and early wound closure, with the transfer of healthy tissues to achieve adequate soft tissue coverage and to protect the vital structures. To date, pedicled skin flap, cross leg skin flap and free skin flap have been frequently applied in clinical practice. Classically, cross-leg flaps have been problematic due to the difficulties with immobilization and positioning of the extremities from the time of initial coverage to detachment. For the pediatric patients with high degree soft tissue injury, free tissue transfer has been indicated for reconstruction of these defects because of the limited local tissue available. In a retrospective analysis, Demirtas et al analyzed the treatment efficiency of free anterolateral thigh flap (ALT) for the management of high-grade car tire foot injuries in children, which indicated that ALT flap with minimal donor site morbidity can be further thinned to adapt to the soft tissue defect, contracted less than muscle flaps and contained a vascularized fascia that could be used for extensor tendon reconstruction. Even though free flap may be a solution for the soft tissue defects, it has been limited in clinical practice in children as its complexity requires microsurgical expertise. Moreover, it is sometimes accompanied by a risk of complete failure.
