Abstract
Objective To explore surgical application of local and free flaps for repair of soft tissue defects at the foot and ankle. Methods Between March 2008 and March 2010, 28 cases of soft tissue defects at the foot and ankle were treated in our department. They were 21 males and 7 females with a mean age of 34. 0 years (range, 6 to 62 years) . Thirteen cases were caused by a traffic accident, 11 cases by machine crush, 2 cases by falling, one by chronic ulcer and one by burning. A local or free flap was used in the repair as an emergency or secondary treatment for all the 28 cases, mainly according to the severity of the soft tissue defects at the foot and ankle. The anterolateral thigh flap was used in 10 cases, the sural neurovascular flap in 8 cases, the medial supramalleolar flap in 4 cases, the lateral tarsal flap in 3 cases, the medial plantar flap in 2 cases and the latissimus dorsi flap in one case. The survival and healing of all the flaps were evaluated postoperatively. Results All the cases were followed up for 4 to 24 months postoperatively, with a mean time of 14 months. Distal flap necrosis occurred in 2 cases and edge necrosis in 2. The necroses were cured after dressing, anti-infection management and skin grafting. The rest were all successful at primary repair, with a good contour, texture and elasticity. The patients had restored their foot and ankle function and walked normally. Conclusions Application of a local or free flap for repair of soft tissue defects at the foot and ankle should depend on the location, size and severity of the injury. For heel and ankle defect repair, sural neurocutaneous flap, medial plantar flap, lateral supramalleolar flap or lateral tarsal flap can be used. A free flap, such as anterolateral thigh flap or latissimus dorsi flap, is the first choice for patients with an extensive open injury. The lateral tarsal flap has an advantage in repair of minor forefoot defects. Key words: Foot injuries; Surgical flaps; Skin transplantation
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