Reconstruction of the Weight-Bearing Surface of the Foot with Nonneurosensory Free Flaps

Abstract

Neurotized fasciocutaneous flaps and split-skin grafted muscle flaps are the most frequently used free flap alternatives for the reconstruction of weight-bearing surfaces of the foot. An objective comparison of the innate characteristics of these two flap types, with respect to long-term stability, has not been possible because sensory reinnervation in the fasciocutaneous flaps has been a confounding factor. This study compares nonsensate fasciocutaneous flaps (n = 9) with nonsensate split-skin grafted muscle flaps (n = 11), with mean follow-up periods of 34.3 and 31.3 months, respectively. Patients completed a form that included questions regarding degree of pain at the operative site, presence of ulcers, ability to wear normal shoes, employment status, and time spent standing on foot. Touch and deep sensation were evaluated with Semmes-Weinstein and vibration tests, respectively. Significantly less pain and less ulceration (p < 0.05) were observed in the fasciocutaneous group. Semmes-Weinstein monofilament tests revealed poorer results with split-skin grafted muscle flaps, compared with fasciocutaneous flaps. These results indicate that even if the sensory protection of fasciocutaneous flaps is not considered, these flaps have superior properties, compared with split-skin grafted muscle flaps.

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

“…We usually performed LD flap with a meshed split-thickness skin graft because of the possibility to check the vitality of the underling muscle and to avoid excessive thickness of the flap, and avoid the usual compressive package of standard unmeshed skin graft. 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].…”

Plantar reconstruction with free thoracodorsal artery perforator flaps

“…lack of flap durability resulting from the sliding phenomenon. 24,25 Recently, a few studies advocating for perforator flaps including anterolateral thigh flaps have been reported. Hong et al reported the role of anterolateral thigh flaps in sole reconstruction.…”

“…When using fasciocutaneous flaps such as the radial forearm free flaps, flap instability due to the sliding phenomenon can result in a major problem. 24,25 The patients who underwent the plantar reconstruction using fasciocutaneous flaps suffered from a feeling of side-to-side instability resulting from the sliding phenomenon. On the other hand, this sliding phenomenon may occur less frequently in the reconstruction using perforator flaps.…”

Reconstruction of the weight‐bearing surface of the foot with integra‐grafted latissimus dorsi muscle flap

“…Nevertheless, split-skin grafted muscle flaps have been claimed to be more stable than fasciocutaneous flaps because they are easily contoured to the recipient area and permit less movement against the underlying skeletal structures, resembling the sole of the foot. 3 On the other hand, recurrent ulcerations is the main disadvantage of muscle flaps indicating the necessity for other reconstructive modality or adjunct. 2,3 In February 2009, a 14-year-old overweighted male sustained a devastating crush-avulsion injury of the sole of his foot.…”

“…3 On the other hand, recurrent ulcerations is the main disadvantage of muscle flaps indicating the necessity for other reconstructive modality or adjunct. 2,3 In February 2009, a 14-year-old overweighted male sustained a devastating crush-avulsion injury of the sole of his foot. He presented with grossly contaminated mangled foot, extensive soft-tissue loss of the plantar weight-bearing area and avulsion of the plantar aponeurosis.…”