One-stage bone and soft tissue reconstruction for complex defects at the midfoot and forefoot

Abstract

Objective To explore a new method to reconstruct the complex tissue defects at the midfoot and forefoot. Methods From January of 2009 to January of 2014,the complex tissue defects at the midfoot and forefoot in 12 patients were reconstructed with iliac osteocutaneous flap based on the superficial circumflex iliac artery which was bridged with or without anterolateral thigh flap. The patients were 9 males and 3 females, from 17 to 58 years of age (average, 41.2 years). The defective areas ranged from 16 cm × 3 cm to 20 cm × 16 cm. Their functional recovery was evaluated clinically and radiologically. Results Eleven iliac osteocutaneous flaps and one iliac osseous flap were harvested. The sizes of the iliac bone segment ranged from 4 cm × 1 cm × 1 cm to 8 cm × 2 cm × 1 cm; the sizes of the skin paddle ranged from 5 cm × 3 cm to 18 cm × 6 cm. Eight cases were treated with a combination with the anteriolateral thigh flap which ranged from 10 cm × 5 cm to 25 cm × 11 cm. The follow-up periods ranged from 12 to 24 months, averaging 18.5 months. Bone union was observed in all cases, with an average period of 3.8 months. Full weight bearing status was achieved after an average period of 6.2 months. The average American Orthopaedic Foot and Ankle Society score was 73.7 points; the average aesthetic satisfaction score was 6.4 points. Conclusions Iliac osteocutaneous flap based on the superficial circumflex iliac artery is a new valuable alternative for reconstruction of complex tissue defects at the midfoot and forefoot. In cases of extensive soft tissue defects, a combination with the anterolateral thigh flap may allow better orientation and coverage. Key words: Surgical flaps; Midfoot and forefoot; Complex defects