Free musculocutaneous and muscle flaps for foot reconstruction: a clinical and gait analysis study

Abstract

Between 1986 and 1995, 48 microvascular flaps (14 fasciocutaneous, 13 muscle, and 21 musculocutaneous) were performed on 47 patients with foot defects. The study group consisted of 19 patients who successfully underwent weightbearing surface reconstruction with free musculocutaneous flaps or muscle flaps with a skin graft. The groups were identified on the basis of the free flap used. Group 1: Latissimus dorsi musculocutaneous flaps (11 patients); group 2: Skin grafted muscle flaps (8 patients: latissimus dorsi - 6, gracilis - 1, rectus abdominis - 1). The follow-up period was 1–11 years (average: 8.3 years). Follow-up included documentation of foot pain, presence of ulceration, sensory recovery, the ability to wear normal shoes, and the need for a second operation. In group 1, debulking operations were necessary (8 patients, 72.7%). Debulking was not required in group 2. Ulceration occurred in four (36.4%) group 1 patients and in one (12.5%) group 2 patient. All patients had good deep pressure sensation. All the group 2 patients could wear normal shoes. Four (36.4%) of the group 1 patients had to wear special orthopedic shoes. The gait analysis consisted of two parts: footprint analysis with the Harris mat technique and plantogram of Parotec system by Kraemer. Foot analysis with the Harris mat showed that the pressure on the muscle flap is less than the pressure on the musculocutaneous flap. Gait analysis by the Parotec system showed that in patients with musculocutaneous flaps, static load distribution on the reconstructed bare foot is nearly normal, but dynamic load distribution is pathological. In patients with muscle flaps, both static and dynamic load distribution were close to normal.