Foot Salvage using Free Flap in the Extensive Soft Tissue Defects

ABSTRACT

Sensation, durability, and aesthetic contour should be considered in reconstructive surgery of the foot. Extensive soft tissue defects in the foot can be successfully reconstructed by proper flap selection. Fifty-one patients underwent 54 cases of free flap reconstruction for extensive soft tissue defects of the foot from March, 1986 to August, 2002. The causes of soft tissue defects in the foot included trauma, burn injury, peripheral vascular disease, and tumor. The used free flaps were lateral arm, radial forearm, scapular, latissimus dorsi, rectus abdominis, and other free flaps. Secondary free flap operations were performed in 3 patients due to flap necrosis by vascular thrombosis. Free flaps were selected with consideration of anatomic, functional, and aesthetic aspects. Thick, durable, and innervated flaps were selected for weight bearing regions, thick flaps for non-weight bearing regions, and thin fasciocutaneous or cutaneous flaps for the dorsum of foot. If the transferred muscle flap was too bulky to allow the patient to wear the shoes, a debulking procedure was performed for functional and aesthetic demands. The end-to-side vascular anastomosis was performed to preserve blood supply to the distal part of the foot. Free flap surgery could obviously provide one stage reconstruction even in the case of complex foot defect including those with bone and tendon damage. We selected the free flaps according to the recipient's specific requirements, and then it provided ambulation, durable foot preservation, and a better quality of life in patients undergoing the reconstruction of extensive soft tissue defects of the foot.