Reconstruction Of Foot Defects Research Articles

The Value of Anterolateral Thigh Free Flap for the Reconstruction of Malignant Melanoma of the Sole of the Foot.

Wide excision of malignant melanoma on the foot usually results in an extensive function-destroying defect, and the reconstruction of foot defects remains challenging for reconstructive surgeons. We propose using anterolateral thigh perforator (ALT) free flaps for the reconstruction of widespread defects caused by malignant melanoma in the sole. This retrospective study included 34 patients who underwent reconstruction of sole defects caused by malignant melanoma resection with 35 ALT perforator free flaps between August 2005 and July 2021. In total, 18 male patients and 16 female patients were included (mean age at surgery, 65.4 years). The mean size of the flaps was 100.4 cm 2 . Thirty-three of the 35 flaps survived. Hematoma, seroma, and chronic ulceration were not identified in any cases. All patients achieved independent ambulation within the follow-up period, except 1 patient with gait discomfort. The 5-year overall and disease-free survival rates of patients were 64.4% and 56.6%, respectively. The ALT flap is a versatile surgical option that should be considered for reconstruction of the sole after malignant melanoma resection, considering its various surgical advantages and the functional aspects of independent ambulation, the aesthetic aspects of wearing conventional footwear, and the anatomical aspects of the sole.

Microsurgical Reconstruction of Foot Defects: A Case Series with Long-Term Follow-Up.

(1) Background: Microsurgical reconstruction of foot defects with free flaps is rare as it is a challenging task for a surgeon. For extensive defects, advanced surgical procedures, such as free flap transfer with microsurgical anastomosis, may be the last chance to avoid major amputation. The aim of the study was to examine the opportunities and risks posed by free flap reconstruction of foot defects and to illustrate in which situations reconstruction is useful on the basis of case characteristics. (2) Methods: In this study, we retrospectively analyzed data of cases with free flap reconstruction of the foot from 2007 to 2022. Therefore, demographic data, comorbidities, information about the defect situation, data on the operational procedure, and complications were evaluated. (3) Results: A total of 27 cases with free flap coverage of foot defects could be included. In 24 of these cases (89%), defect coverage was successful. In 18 patients, some form of complication occurred in the postoperative stage. The most frequently used flap was the latissimus dorsi flap, with 13 procedures. (4) Conclusions: Foot reconstruction using free flaps is a proven procedure for the treatment of larger foot defects and can offer a predominantly good functional outcome. The lengthy process and possible complications should be thoroughly discussed in advance so as to provide criteria, suitably adjusted to the individual prerequisites of the patients, for deciding whether limb salvage using advanced surgical procedures should be attempted.

Reconstruction of Hind and Mid-Foot Defects after Melanoma Resection Using the Reverse Sural Flap: A Case Series.

Background Melanoma resection creates important soft tissues defects, which are difficult to manage when located on the weight-bearing heel and mid foot. There is little evidence on the use of the reverse-flow sural flap for this type of reconstruction. Objective This study reports our case series on the reconstructive management of the hind and mid-foot defects after melanoma resection using the reverse sural artery flap. Materials and Methods This is a retrospective study of four consecutive patients treated with resection of melanoma of the feet and reconstruction with reverse sural artery flap from 2006 to 2009. Results The mean age of the patients was 54 years, three were females, and one was male. Three of the defects were located on the weight-bearing heel, the other on the mid-foot dorsum. The melanomas were fully resected with wide margins. Three patients were reconstructed primarily, whereas one patient was reconstructed 4 weeks after the resective surgery. This series revealed 100% flap survival and there was no partial necrosis. Major complications were not observed. The four patients completely recovered the function of the affected limb. Conclusion The reverse sural flap is a viable option for the reconstruction of foot defects after melanoma resection.

Reconstruction Outcomes of Oncologic Foot Defect Using Well-Contoured Free Perforator Flaps.

Reconstruction of foot defects following oncologic resection is a crucial element in the treatment of soft tissue malignancy of the foot. The present study aimed to comprehensively evaluate outcomes of oncologic foot reconstruction using free perforator flaps. Outcomes of patients with soft tissue malignancy of the foot who underwent reconstruction using a free perforator flap following ablative surgery were reviewed, and perioperative and delayed complications (secondary debulking operation and flap instability) were documented. The Foot Function Index (FFI) questionnaire was surveyed to assess functional status. Overall, 72 patients were analyzed, with a median follow-up period of 28months. Malignant melanoma was a predominant etiology. Three kinds of perforator flaps were used, with the thoracodorsal artery perforator flap being the most common. Flaps with skin dimensions matching the defect size were inset and the thickness of the flaps was controlled with primary defatting. Flap re-exploration was conducted in 11 (15.2%) cases and total flap loss occurred in 3 (4.2%) cases. Delayed complications developed in an additional 12 cases, therefore 23 (31.9%) cases required a return to the operating room. The average FFI score was 8.86 at postoperative month 36, on average (range 11-128months). All respondents reported being independently ambulatory and had minimal difficulty in their daily lives. Reconstruction of defects on weight-bearing regions showed a significantly higher FFI score than that on nonweight-bearing regions (mean 11.96 vs. 4.79, p=0.029), although the scores remained very low for both instances. Oncologic foot defects can be reliably reconstructed using well-contoured free perforator flaps with minimal functional morbidity.

Negative pressure wound therapy in the management of mine blast injuries of lower limbs: Lessons learnt at a tertiary care center

BackgroundMine blast injuries of foot are devastating injuries that result in composite tissue loss or amputations. Negative pressure wound therapy has helped in the management of such combat-related wounds. The aim of this study was to report experiences gained in managing such injuries at a tertiary care center. Methods17 combatants who sustained mine blast injuries were included in this study. Severity of foot injury was assessed as per Foot and Ankle Severity Score. After wound debridement, negative pressure wound therapy was started and foot defect was appropriately reconstructed. Following wound healing, the foot was assessed for Foot and Ankle Severity Score in terms of impairment. The patients were then suitably rehabilitated by shoe modifications, orthosis, or custom-made prosthesis. ResultsMean age of soldiers who sustained mine blast injuries was 30.2 years. The mean Foot and Ankle Severity Score was 3.76. Temporary wound closure was achieved using negative pressure wound therapy and it prevented local and systemic infection. The defect could be reconstructed appropriately using split skin graft, regional fasciocutaneous flap, or microvascular free flap. Mean time to definitive reconstructive procedure was 16.5 days. Mean Foot and Ankle Severity Score in terms of impairment was 4.11. All soldiers could be rehabilitated and were returned to their respective units and were able to perform sedentary duties assigned to them. ConclusionThe negative pressure wound therapy was helpful in preventing proximal amputations due to mine blast injury and was helpful in satisfactory reconstruction of foot defects.

Reconstruction of Foot Defects With Free Lateral Arm Fasciocutaneous Flaps: Analysis of Fifty Patients

Reconstruction of Foot Defects With Free Lateral Arm Fasciocutaneous Flaps: Analysis of Fifty Patients

Repairation of defects of bones of foot and soft tissue by using composed tissue transfer

目的 研究解决足部创伤及疾病造成的足骨及软组织缺损的修复重建方法,减少和减轻足残疾和功能不良率,最大限度的恢复足功能和外型.方法对足背、前足、足跟、踝下等部位单纯软组织缺损,采用局部转移或旋转皮支皮瓣、筋膜皮瓣、游离皮瓣、全厚皮片植皮等方法修复;足底负重区采用预制皮瓣方法解决;前足、足跟及其它跗骨复合组织缺损采用带血管髂骨加皮瓣组织移植重建;内、外踝缺损应予以重建.结果 247例经上述方法处理,临床疗效满意.按美国AOFAS踝-足评分标准:优84例,良107例,可42例,差14例.结论髂骨为一扁平状骨,血运丰富,用于重建再造跖骨缺损尤其是多跖骨缺损、跟骨缺损时,接地稳定且触地面积大,便于负重、固定及承压.内、外踝可取带筋膜的髂骨和腓骨头重建骨及韧带缺损.组合带血管骨与皮瓣修复缺损,可将移植骨及皮瓣各自先充分对位满意后再行组合,较理想地恢复足的解剖和生理功能。

Reconstruction of foot defects with free lateral arm fasciocutaneous flaps: Analysis of fifty patients

In this article, long-term outcomes of foot reconstruction with free lateral arm fasciocutaneous flaps were retrospectively analyzed in 50 patients. The patients, 38 men and 12 women, ranged in age from 7-73 years (mean, 43.5 years). Indications for surgery included trauma (32 patients), diabetes mellitus (7 patients), burns (7 patients), chronic ulcers (3 patients), and tumor (1 patient). The locations of defects were the dorsum (n=21), ankle (n=12), medial (n=6), lateral (n=6), posterior heel (n=2), and distal sole (n=3) Concomitant bone injury occurred in 5 cases, and the weight-bearing surface of the foot was involved in 5 patients. Defects ranged in size from 27-76 cm(2) (mean, 36.4 cm(2)). Successful reconstructions were accomplished in 46 cases (92%). Flap complications included total flap loss and below-knee amputation (1 patient) and partial flap loss (3 patients); 75% (3/4) of these cases had diabetes as a comorbid factor, and 25% (1/4) had a concomitant bone injury. Six patients with dorsum defects required debulking of the flap (11.1%). None of the patients required modified shoes. In the majority of cases, flaps provided stable coverage and a gain in protective deep-pressure sensation. In long-term follow-up (up to 4 years), patients regained their ambulation, free of pain. Even in weight-bearing areas, none of the cases experienced ulceration or skin breakdown. Free lateral arm flaps provided excellent durability, with solid bony union and successful restoration of the contour of the foot in moderate-sized foot defects.

Reconstruction of foot defects due to mine explosion using muscle flaps.

Landmine explosions bring a formidable challenge to both patients and reconstructive surgeons. Free tissue transfer is the only method of repairing such extensive soft tissue defects of the foot after serial debridements. Sixty-five consecutive free muscle flap transfers were performed in 54 patients who had foot defects involving soft tissue and bone due to mine explosions. Although posttraumatic vessel disease had complicated most of the cases, overall flap survival rate was 83%. Each patient was ambulatory. Ulceration in long-term period was seen in only one patient. Eighty-five percent of patients with successful bone reconstruction and 41.6% of patients without adequate bone replacement demonstrated normal weightbearing in footprints and gait analysis. Free muscle flaps with split thickness skin graft and bone replacement are recommended for the reconstruction of such devastating wounds.

Microsurgical tissue autotransplantation in cases of posttraumatic reconstruction of foot defects

Microsurgical tissue autotransplantation in cases of posttraumatic reconstruction of foot defects

Mechanical sensibility in free and island flaps of the foot.

Mechanical sensibility in 20 free skin flaps and four dorsalis pedis island flaps, used for the reconstruction of foot defects, was analyzed with conventional clinical methods and by determining sensibility thresholds to vibration frequencies of 20, 80, and 240 Hz. To eliminate inter-individual variability, a score was calculated for each frequency by dividing the thresholds determined for each flap with values obtained from the corresponding area on the uninjured foot. The soft tissue stability of the reconstruction was assessed. Patients were divided into three groups according to the scores. In the group of flaps with the best sensibility, the threshold increases were low at all frequencies. In the group with intermediate sensibility, the relative threshold increases were greater, the higher the frequency. In the group with the poorest sensibility, no thresholds were obtained with 240 Hz frequency and the thresholds increases were very high at all frequencies. Sensibility was not related to the length of follow-up time, nor to the type or size of the flap. However, flap sensibility was closely associated with that of the recipient area, where sensibility was usually inferior to that of normal skin. The island flaps generally had better sensibility than the free flaps. There was a good correspondence between the levels of sensibility determined by clinical and quantitative methods. The quantitative data on the level of sensibility obtained with the psychophysical method were found to be reliable and free from observer bias, and are therefore recommended for future studies. The degree of sensibility may have contributed to, but was not essential for, good soft-tissue stability of the reconstruction.