Soft-Tissue Reconstruction of Sole and Heel Defects With Free Tissue Transfers

Yücel, Ayhan; Şenyuva, Cemal; Aydın, Yağmur; Çınar, Can; Güzel, Zeki

doi:10.1097/00000637-200044030-00003

Cited by 64 publications

(62 citation statements)

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“…16 Gait analysis of patients that underwent sole and heel reconstruction revealed an asymmetrical and abnormal compensatory gait pattern with limited pressure amplitude and duration at the reconstructed site, unconsciously aiming at flap protection. 28,33,34 However, no differences in gait pattern and walking ability were observed between fasciocutaneous and muscle flaps. 28 In our patient, the differences in dynamic plantar pressure distribution patterns between both feet detected by pedography indicated the impact of trauma on the left foot.…”

Section: Discussionmentioning

confidence: 94%

“…28,33,34 However, no differences in gait pattern and walking ability were observed between fasciocutaneous and muscle flaps. 28 In our patient, the differences in dynamic plantar pressure distribution patterns between both feet detected by pedography indicated the impact of trauma on the left foot. Deviations of the arch index and hallux angle, increased contact area of the midfoot, and elevated peak pressures at the forefoot reflected residual deformities of the left foot skeleton.…”

Section: Discussionmentioning

confidence: 94%

“…[24][25][26] However, fasciocutaneous flaps are advantageous in superficial defects without bony irregularities, because they are thin and pliable and provide better sensation. [27][28][29] Protective sensation is important for flap durability in weight-bearing areas, and has repeatedly been reported in muscle flaps and fasciocutaneous flaps alike. 28,[30][31][32] However, the debate about innervated flaps for reconstruction of plantar defects is controversial.…”

Section: Discussionmentioning

confidence: 98%

“…[27][28][29] Protective sensation is important for flap durability in weight-bearing areas, and has repeatedly been reported in muscle flaps and fasciocutaneous flaps alike. 28,[30][31][32] However, the debate about innervated flaps for reconstruction of plantar defects is controversial. Although tactile sensation is clearly superior in fasciocutaneous flaps, this does not appear to be necessary to maintain an intact and functional plantar surface.…”

Section: Discussionmentioning

confidence: 98%

“…Although tactile sensation is clearly superior in fasciocutaneous flaps, this does not appear to be necessary to maintain an intact and functional plantar surface. 27,28,[30][31][32] Nevertheless, flaps transferred to insensate areas are more prone to damage because of the lack of deep pressure sensation and unfavorable weight distribution. 32 Patients with impaired sensation may therefore benefit from innervated flaps.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Instep free flap for plantar soft tissue reconstruction: Indications and options

2007

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Pedicled instep flaps are frequently used in weight-bearing plantar reconstruction, but may not be available after severe foot injuries. Although free instep flaps offer a viable option, they have scarcely been reported. A posttraumatic plantar forefoot defect was reconstructed with a sensate, instep free flap, because local flaps were not available and defect size did not require a distant free flap, and the current literature was reviewed for therapeutic options. The instep free flap yielded an excellent functional and aesthetic long-term result. In the literature, pedicled instep flaps are advocated for moderate size defects of the weight-bearing heel and sole, while free flaps from distant sites are preferred for large defects. Although skin-grafted muscle flaps and fasciocutaneous flaps yield similar results, reconstruction by like tissues appears favorable. We suggest the instep free flap for weight-bearing plantar foot reconstruction, when pedicled instep flaps are not available and distant free flaps are avoidable.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Instep free flap for plantar soft tissue reconstruction: Indications and options

2007

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Utility of toe fillet flaps for reconstruct of the forefoot in cases of plantar melanoma

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et al. 2020

Journal of Surgical Oncology

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Reconstruction of foot defects with free lateral arm fasciocutaneous flaps: Analysis of fifty patients

et al. 2005

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In this article, long-term outcomes of foot reconstruction with free lateral arm fasciocutaneous flaps were retrospectively analyzed in 50 patients. The patients, 38 men and 12 women, ranged in age from 7-73 years (mean, 43.5 years). Indications for surgery included trauma (32 patients), diabetes mellitus (7 patients), burns (7 patients), chronic ulcers (3 patients), and tumor (1 patient). The locations of defects were the dorsum (n=21), ankle (n=12), medial (n=6), lateral (n=6), posterior heel (n=2), and distal sole (n=3) Concomitant bone injury occurred in 5 cases, and the weight-bearing surface of the foot was involved in 5 patients. Defects ranged in size from 27-76 cm(2) (mean, 36.4 cm(2)). Successful reconstructions were accomplished in 46 cases (92%). Flap complications included total flap loss and below-knee amputation (1 patient) and partial flap loss (3 patients); 75% (3/4) of these cases had diabetes as a comorbid factor, and 25% (1/4) had a concomitant bone injury. Six patients with dorsum defects required debulking of the flap (11.1%). None of the patients required modified shoes. In the majority of cases, flaps provided stable coverage and a gain in protective deep-pressure sensation. In long-term follow-up (up to 4 years), patients regained their ambulation, free of pain. Even in weight-bearing areas, none of the cases experienced ulceration or skin breakdown. Free lateral arm flaps provided excellent durability, with solid bony union and successful restoration of the contour of the foot in moderate-sized foot defects.

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Soft-Tissue Reconstruction of Sole and Heel Defects With Free Tissue Transfers

Cited by 64 publications

References 0 publications

Instep free flap for plantar soft tissue reconstruction: Indications and options

Instep free flap for plantar soft tissue reconstruction: Indications and options

Utility of toe fillet flaps for reconstruct of the forefoot in cases of plantar melanoma

Reconstruction of foot defects with free lateral arm fasciocutaneous flaps: Analysis of fifty patients

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