Free Flap Reconstruction of the Sole of the Foot with or without Sensory Nerve Coaptation

Microvascular reconstruction of complex foot defects, a new anatomo-functional classification

“…In seventeen cases (35.4%) flaps were re-innervated through surgical coaptation to the sural nerve (14 cases), tibial branch (two cases) and common peroneal branch (one case), to obtain a protective re-innervation of the skin island [7].…”

“…Unfortunately, we experienced in the medium term followup several problems related to ulcerations, and fissures of the skin riepithelialized over muscle reconstruction, because of its fragility and lack of sensory reinnervation [24], leading to additional reconstructive procedures in about 50% of the patients [25]. We therefore suggest the use in large plantar WB defects (ST-II-P-WB) of innervated or reinnervated fasciocutaneous flaps as ulceration is less frequent and hyperkeratosis or hypertrophic scarring can be reduced when anatomic boundaries are respected, allowing patients to rehabilitate completely [7,17]. Is also well known that flap debulking, provides thin, versatile coverage, allowing good contouring of the plantar surface and avoiding fat sliding [22].…”

Neurotized Distally Based Sural Flap for Heel Reconstruction

“…When free neurosensitive flaps are compared with nonsensitive flaps for the reconstruction of the plantar aspect of the foot and the heel, it has been demonstrated that the group of patients treated with sensory flaps are incorporated into their work faster and with better perception of sensitivity and support pressure values, similar to those recorded at the healthy nonreconstructed foot. [22][23][24][25][26] Masquelet et al 11 concluded that the design of the skin paddle can be outlined anywhere on the suprafascial course of the nerve, and the neuroskin should not be considered as a sensate flap, as well as the main problem is the loss of a superficial sensitive nerve. We think that the inclusion of the nerve is justified not because of the neurocutaneous perforators arising from the small arteries accompanying the sural nerve 19 but because it serves as the source of reestablishing sensibility when coapted to another superficial nerve.…”

Der modifizierte erweiterte distal gestielte sapheno-fasziokutane Suralislappen

“…Desweiteren erfordern freie muskulokutane Lappen nicht selten spätere Debulkingeingriffe [20,27]. Da auch keine langfristigen Vorteile der sensiblen kutanen Lappen versus der nichtinnervierten freien Muskellappen hinsichtlich der späten Ulzera und keine pedobarographischen Unterschiede bei innervierten versus nichtinnervierten freien Lappen bestehen [18,26], rücken komplikationsarme, zuverlässige und kostensparende Versorgungsverfahren zunehmend in den Mittelpunkt [15]. Hinzu kommt, dass Modifikationen des Suralislappens als muskulokutane Lappen ebenfalls die Vorteile der freien Muskellappen bieten ohne deren Aufwand bzw.…”

“…Langfristig entwickeln auch nichtsensible Lappen eine ausreichende protopathische bzw. protektive Sensibilität [26].…”