The use of the anterior lateral flap as a stage of orthopedic treatment for post-traumatic deformation of the tibia in children

Background and Aims

Complex open tibial fractures with soft tissue defects in children represent a major clinical challenge due to high risks of infection, osteomyelitis, and long-term functional impairment. This study aimed to evaluate the effectiveness of a combined orthopedic and reconstructive approach using external fixation and free anterolateral thigh (ALT) flaps in pediatric patients.

Methods

In this prospective, controlled clinical trial, 78 children (mean age 12.4 ± 3.1 years) with open tibial fractures and extensive soft tissue loss from road traffic accidents were enrolled. Patients were randomized into two groups: the experimental group (n = 40) received Ilizarov external fixation with microsurgical ALT flap reconstruction; the control group (n = 38) underwent conventional internal fixation with standard wound management. Renal function markers (creatinine, urea, GFR) were monitored to assess the impact of trauma, systemic inflammation, and nephrotoxic antibiotic exposure. Healing was evaluated using the Zygo-Scale at 7, 30, 60, 90 days, and 12 months. Incidence of osteomyelitis, joint ankylosis, flap complications, and revision surgeries was recorded.

Results

The experimental group demonstrated significantly faster and more complete soft tissue healing (p ≤ 0.05), with lower rates of osteomyelitis at 6 and 12 months (2.5 % and 0 % vs. 10.5 % and 5.25 %, respectively; p < 0.05). Joint ankylosis scores were also significantly reduced (p = 0.02 and p = 0.01). Flap survival rate was 95 %, with no cases of total necrosis. Donor site morbidity was minimal. While renal function improved in both groups, a modest but significant difference in creatinine levels at 12 months favored the experimental group (p = 0.03). The combined approach was associated with shorter healing times and fewer complications.

Conclusion

The integration of Ilizarov fixation with ALT flap reconstruction is a safe and effective strategy for managing severe pediatric lower limb injuries, enhancing healing, reducing infections, and improving functional outcomes. Monitoring renal markers provides insight into systemic stress and antibiotic safety in trauma care.