Thin Free Perforator Flap as a Viable Option for Forefoot Reconstruction: Comprehensive Evaluation of Outcomes

Abstract

Background: Reconstruction of forefoot defects often necessitates free tissue transfer due to the limited availability of local tissue. Microsurgical reconstruction of the forefoot remains challenging as it requires durable yet thin, soft tissue coverage for functional restoration. This study aimed to evaluate the efficacy of free thin perforator flaps for forefoot reconstruction, with a focus on functional outcomes. Methods: Patients who underwent microsurgical forefoot reconstruction between March 2020 and September 2023 were reviewed. Development of postoperative complications and functional outcomes were evaluated. Results: In total 53 patients were analyzed, with a mean age of 62.7 years. The most common etiology of defects was oncologic surgery, followed by chronic wound, with a majority involving the plantar side. Super-thin anterolateral thigh flap and superficial circumflex iliac artery perforator flap were predominantly used. The median thickness of the flap was 4.0 mm. Digital vessels were the most frequently used as recipients. All but one flap survived, resulting in a success rate of 98.1 percent. Postoperative flap-site complications developed in 20 patients, the majority of which were resolved with conservative treatment. The median hospital stay was 8.0 days, and the mean time for initiating weight-bearing ambulation was 12.4 days. In postoperative foot function index questionnaire survey, the overall score remained 9.41, showing minimal impairment, and did not differ according to defect size and locations. Secondary debulking operation was necessitated in seven patients. Conclusion: Use of thin free perforator flaps might provide reliable outcomes with rapid recovery and excellent postoperative function in the forefoot reconstruction.