Very limited literature described the use of the free anterolateral thigh (ALT) among other flaps for pediatric lower limb reconstruction. The
aim of this study is to present our experience using the free ALT flap for reconstruction of soft tissue defects over the dorsum of the foot
and ankle in children. The study included 42 children aged 2.5–13 years with a mean of 6.18 years. Three children had crush injuries while
the rest were victims of run over car accidents. All of the flaps were vascularized by at least two perforators; 88.23% were musculocutaneous
and 11.77 were septocutaneous perforators. All flaps were raised in a subfascial plane. Initial thinning was performed in five flaps and
35% required subsequent debulking. Mean Flap surface area was 117.11 cm2. The recipient arteries were the anterior tibial artery in 38
cases and posterior tibial artery in four cases. Venous anastomosis was performed to one vena commitant and in nine cases the long
saphenous vein was additionally used. Mean ischemia time of the flap was 2 hours while total operative time averaged 6.3 hours. About
41% of donor sites were closed primarily while 59% required skin grafting. Primary flap survival rate was 92.8% (39/42 cases). Three flaps
showed venous congestion. After venous reanastomosis, two flaps showed partial loss and one flap was lost completely. Post-operative
hospital stay averaged 7.5 days. The free ALT flap could be as safe, reliable, and aesthetically appealing option for foot/ankle resurfacing
in children after traumatic soft tissue loss.