Reconstruction of Soft-Tissue Defects at the Foot and Ankle after Oncological Resection

Abstract

IntroductionSolid malignancies at the foot and ankle region are rare and include mainly soft-tissue sarcomas, bone sarcomas, and skin malignancies. Complete surgical resection with clear margins still remains the mainstay of therapy in these malignancies. However, attainment of negative surgical margins in patients with locally advanced tumors of the foot and ankle region may require extensive surgery and could result in loss of extremity function. In these circumstances, plastic surgical techniques can frequently reduce functional impairment and cover soft-tissue defects, particularly in cases of large tumor size or localization adjacent to critical anatomic structures, thereby improving the quality of life for these patients. The aim of this article is to illustrate the various treatment options of plastic surgery in the multimodal therapy of patients with malignant tumors of the foot and ankle region.Materials and methodsThis article is based on the review of the current literature and the evaluation of the author’s own patient database.ResultsThe local treatment of malignant extremity tumors has undergone major changes over the last few decades. Primary amputations have been increasingly replaced by limb-sparing techniques, preserving extremity function as much as possible. Although defect coverage at the foot and ankle region is demanding due to complex anatomical features and functional requirements, several plastic surgical treatment options can be implemented in the curative treatment of patients with malignant solid tumors in this area. Soft-tissue defects after tumor resection can be covered by a variety of local flaps. If local flaps are not applicable, free flap transfers, such as the anterolateral thigh flap, parascapular flap, or latissimus dorsi flap, can be utilized to cover nearly all kinds of defects in the foot and ankle region.ConclusionSoft-tissue reconstruction in the foot and ankle region is a vital component of limb-sparing surgery. It enables complete resection of locally advanced tumors and subsequent adjuvant radiotherapy. Modern plastic surgical techniques should, therefore, be integrated in the multimodal treatment concept of malignancies in the foot and ankle region.

Comparing Outcomes for Fasciocutaneous versus Muscle Flaps in Foot and Ankle Free Flap Reconstruction

“…Both flaps offer several advantages that increase their utility in distal lower extremity reconstruction, including ease of harvest, versatility, relatively constant anatomy, and a long vascular pedicle with good vessel caliber. [17][18][19][20][21] Critically, both fasciocutaneous flaps offer minimal morbidity at the donor site as compared with muscle flaps. 21,22 This is particularly valuable in the setting of polytraumas, where preservation of core muscles such as the latissimus dorsi and rectus abdominis can be essential for rehabilitation.…”

Anatomic Reconstruction of Lateral Ankle Ligaments and Both Peroneus Tendons After Open Fracture Dislocation of the Ankle: A Case Report

“…Various reconstructive procedures are available for the treatment of extensive soft tissue injuries of the ankle. 5,11,14 Depending on the extent of the remaining normal tissue, surgeons should choose the most appropriate procedures. To achieve full functional recovery, it is important to stabilize the ankle without limiting the range of motion.…”

“…The treatment of extensive soft tissue defects of the ankle resulting from high-energy trauma or tumor resection is challenging. 5,11,14 Tendons and ligaments are essential for normal movement and stability of the ankle, and loss of these tissues requires functional reconstruction. Anatomic reconstruction using a tissue graft to treat chronic lateral ankle instability or peroneus tendon injury has gained popularity and has favorable clinical results.…”

Medial sural artery perforator free flap for the reconstruction of leg, foot and ankle defect: an excellent option

“…There are many reconstructive options for the defects around the leg, foot and ankle . The ideal flap for leg and foot defects should be thin and pliable cutaneous flap with good tissue match.…”

“…There are many reconstructive options for the defects around the leg, foot and ankle. [2][3][4][5][6] The ideal flap for leg and foot defects should be thin and pliable cutaneous flap with good tissue match. With advances in plastic surgery there is wide expansion of options for the reconstruction.…”