原文
因此兒童足踝部的皮膚軟組織缺損能夠一期修復(fù)的最好進(jìn)行一期修復(fù)。即使部分病例在外院無法一期修復(fù)，轉(zhuǎn)入后也應(yīng)爭取盡早修復(fù)。對于兒童足踝部皮膚軟組織缺損的修復(fù)方法的選擇，要充分考慮其繼續(xù)生長發(fā)育的生理特點。因此不但要覆蓋創(chuàng)面，而且盡量要減少供區(qū)功能發(fā)育的影響。那些可能導(dǎo)致肌肉或大血管功能損害的修復(fù)手段要盡量避免使用。既往經(jīng)常使用的修復(fù)方法包括局部帶蒂皮瓣，交腿皮瓣和游離皮瓣。交腿皮瓣雖然在成人中應(yīng)用較為成功，但是對于兒童來說長時間體位不適的固定使它的應(yīng)用受到限制2,3。對于足踝部較大面積皮膚缺損，有些作者喜歡應(yīng)用游離皮瓣，并證實了手術(shù)的安全性。Yener特別指出股前外側(cè)皮瓣的優(yōu)點包括皮瓣位于股前外側(cè)，可以允許兩個手術(shù)組同時開展手術(shù)，從而縮短手術(shù)時間；可切取的皮瓣面積較大并有較長的血管蒂；在需要的時候皮瓣可包含多種不同的組織；另外供區(qū)功能外形損害較輕。但游離移植畢竟有一定風(fēng)險，而且它復(fù)雜的技術(shù)需要特殊訓(xùn)練的顯微外科醫(yī)生，特殊的設(shè)備也不是隨時都可得到的，而且一旦失敗會導(dǎo)致皮瓣的全部壞死。這些因素都限制了它在一些醫(yī)院中在兒童傷后急需一期手術(shù)覆蓋創(chuàng)面時的應(yīng)用。

譯文
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.