Reverse-Flow Intrinsic Fasciocutaneous Island Flaps in Foot Reconstruction

Abstract

Reconstruction of soft tissue defects in the foot remains a challenge due to its specialized tissue for weightbearing and ambulation. Considering the principle of replacing "like with like," adjacent soft tissues would be a best option for a donor site. Although several kinds of reverse-flow island flaps for the lower leg have been well described, intrinsic foot reverse flow flaps have been rarely reported. We describe 3 kinds of reverse-flow intrinsic fasciocutaneous flaps (RIFFs) for foot reconstruction. From September 2012 to August 2015, a retrospective study was done on case notes of all patients who had a RIFF for coverage of soft tissue defects within the foot following trauma or tumor ablation. A total of 7 patients were included in this study, with an average of 5 × 3.5 cm sized defects in the forefoot, second and third web space, and sole, which were reconstructed with RIFF. All flaps were well perfused and recovered excellent function of the foot with satisfactory aesthetics and minimal limitations in range of motion. However, one case showed a complication of venous congestion, due to remnant scar tissues, which resolved after medical leech application. Donor defects healed completely with split thickness skin grafting in all cases. Soft tissue defects within the foot were repaired successfully by RIFF. In spite of its technical challenges, it is a reliable one-stage procedure requiring no microsurgical anastomosis. Precise vascular evaluation of the reverse inflow has to be preceded for satisfactory outcome of RIFF.

Anterior Tibial to Dorsalis Pedis Bypass to Manage Acute Ischemia Attributed to Pilon Fracture

“…While, in general, various modalities and techniques have been suggested to manage post-fasciotomy wounds and skin defects, the presence of vascular grafts and anastomoses on site poses an additional challenge, reflecting not only the advanced surgical skills that should be recruited in such complex traumas but also the vascular awareness of the physicians when confronting orthopedic traumas. [10][11][12] The issue of primary intravascular shunting in combined orthopedic and vascular extremity trauma is a matter of debate. 13,14 Admittedly, there is a lack of comparative data in the literature regaring the use of temporal intravascular shunt and no consistency in applied reporting standards, retaining controversies regarding the efficacy of these shunts.…”

Anterolateral Thigh Free Flap to Cover Diabetic Foot Defect by Using Reverse Flow of Severely Calcified Dorsalis Pedis Artery

“…Each angiosome is connected at a different level to the leg arteries called "choke vessels" that supply the damaged angiosome territory with sufficient blood A B [7,9]. In addition, a free flap can be placed to maintain blood flow by reversing the distal outflow [10]. Specifically, the deep plantar branch of the DPA from the ATA and the lateral plantar artery of the PTA are connected to form an arch at the subdermal level [9].…”

“…However, reverse arterial blood flow was sufficiently restored, which could be used in anastomosis. Since several successful cases of foot intrinsic fasciocutaneous island flap using a reverse flow pattern were performed prior to this case [10], we were able to reconstruct the large defect of the injured foot using limited reverse flow from the PTA to the ATA. There are no clear contraindications for limb salvage in ischemic foot injuries, and plastic surgeons can achieve successful results in active reconstruction even in severely occluded vessels with calcifications after mechanical interventions.…”