Reconstruction of a Distal Foot Skin Defect Using an Intermediate Dorsal Neurocutaneous Flap

Abstract

Objective: To present the use of an intermediate dorsal neurocutaneous flap for the reconstruction of defects on the distal foot.Methods: From September 2016 to October 2018, five patients (mean age at operation 33.8 years; range, 7-70 years; female/male = 2/3) with skin defects on one of their feet caused by road-traffic accidents, electrical injury, and syndactyly correction were retrospectively reviewed. The size of the defects ranged from 2.0 cm × 1.0 cm to 5.0 cm × 3.5 cm. All patients had undergone a reconstruction surgery using intermediate dorsal neurocutaneous flap. One patient underwent a syndactyly correction, and four patients first experienced aggressive debridement. The sizes of the flaps were between 5.0 cm × 2.0 cm and 6.0 cm × 4.0 cm. The function, appearance, and pain of the injured foot were assessed using the Chinese Manchester Foot Pain and Disability Index and visual analogue scale.Results: These five patients were systematically followed up for a mean of 15.8 months (range, 12-20 months). The donor sites were closed primarily in two cases, and skin grafts were performed in three cases. All the flaps survived with a success rate of 100%; the wounds healed well, and the color matches were excellent. Partial superficial flap necrosis occurred in one of five flaps, which was treated by dressing change using a hypertonic saline gauze. No significant problems were found at the donor site in any patient immediately afterwards or at follow-up. There were no problems in any patients associated with wearing shoes. Based on the Chinese Manchester Foot Pain and Disability Index, four patients were strongly satisfied and one was satisfied with the recovery of physical function; all the patients were strongly satisfied with the appearance of the injured foot; all five patients had an excellent score of pain intensity subscale. Except for one patient who reported mild pain, all the other patients reported no pain based on the visual analogue scale. Two typical cases are presented in this paper. Conclusions:The intermediate dorsal neurocutaneous flap is an alternative and effective technique that can reliably cover minor-to medium-sized defects on the distal foot, toes, and web spaces. This surgical method leads to satisfactory functional recovery with minimal donor site morbidity, and no major vessels need to be sacrificed. This procedure offers an advisable option for orthopaedic surgeons to treat defects on the distal foot.

Superficial Circumflex Iliac Artery Perforator Flap with Bilobed Design for the Donor Defect after Wrap‐Around Flap Transfer Reconstruction

“…All SCIP flaps survived successfully. According to a previous report, Liu et al repaired five cases of distal foot skin defects using the median dorsal neurocutaneous flap, of which only one case showed superficial necrosis 15 . We follow up for more than 30.5 months on average to obtain the most accurate and detailed surgical results and patient satisfaction.…”

“…According to reports, Liu et al used the dorsal intermediate neurocutaneous flap to reconstruct the distal foot skin defect and achieved good patient satisfaction. However, it still does not solve the toe deformity and pain caused by ordinary skin flaps, and the skin flap cannot effectively cover the entire toe 15 . The free superficial iliac artery perforator (SCIP) flap uses the superficial iliac artery as the pedicle.…”

“…However, it still does not solve the toe deformity and pain caused by ordinary skin flaps, and the skin flap cannot effectively cover the entire toe. 15 The free superficial iliac artery perforator (SCIP) flap uses the superficial iliac artery as the pedicle. Although the diameter of this vessel is relatively small and the anatomy is not constant, the flap has the advantage of being soft and having a large area to be cut.…”

Variations in Innervation Pattern to Dorsum of Foot by Medial Dorsal Cutaneous Nerve, Intermediate Dorsal Cutaneous Nerve, Lateral Dorsal Cutaneous Nerve with Surgical and Clinical Correlations: A Cadaveric Dissection Based Study

“…By applying this concept, the neuroskin island flaps can be developed [2,3]. Medial dorsal cutaneous nerves flap and intermediate dorsal cutaneous nerves flap can be used to cover soft tissue defects on middle of the dorsum of the foot and also for small sized skin and soft tissue defects in distal dorsalis pedis [4,5]. The intermediate dorsal cutaneous nerve flap can also be used as an alternative and effective technique to cover soft tissue defects on toes and web spaces.…”

“…The intermediate dorsal cutaneous nerve flap can also be used as an alternative and effective technique to cover soft tissue defects on toes and web spaces. It has the advantage of minimal donor site morbidity and the artery need not be sacrified [5]. First dorsal metatarsal artery flap which consists of the branch of deep peroneal nerve to the first web space has also proved to restore sensory functions in reconstructing the soft tissue defect on great toe [6].…”