Soft Tissue Reconstruction Of Foot Research Articles

Application of the distally based sural neurocutaneous flaps in the management of foot and ankle defects in patients with diabetic foot.

BackgroundWe report our experience on the use of a distally based sural flap for soft tissue reconstruction of foot and ankle defects in patients with diabetic foot.MethodsThe actual study is a retrospective, open, non-controlled, and clinical study of 25 patients treated with diabetic foot on whom reconstruction with distally based sural neurocutaneous flaps was performed from May 2019 to December 2021.ResultsThe mean age was 64.9 years, and there were 15 male and 10 female patients. The mean follow-up was 9.8 months, which ranged from 6 to 12 months. The size of the flaps ranged from 6 × 5 to 15 × 9 cm2. Twenty-two of the 25 flaps survived intact with sufficient blood supply. Two cases had a small superficial necrosis, which was resolved after a change of daily dressing and was heeled eventually. In one case, partial necrosis was observed that was managed with minor revision and the use of split-thickness skin graft.ConclusionsThe distally based sural flap is considered to be useful for reconstruction of foot and ankle defects in patients with diabetic foot.

Soft tissue reconstruction of foot and ankle defect using various flap cover: single centre experience

Introduction: Soft tissue defect at ankle and foot region are very common following road traffic accident. Reconstruction in this region is challenging to surgeon because of poor vascularity and paucity of available surrounding tissue. Purpose of study is to evaluate various ankle and foot defect, advantage and disadvantages of different methods of management, future prospective of suitable method according to defect.Materials and Methods: Retrospective study of 65 patients with soft tissue defects around foot and ankle region underwent various reconstructive procedures at SMS hospital Jaipur from January 2020 to December 2020. Study enumerates various etiological factors and describes different reconstructive surgical procedures.Results: Age at presentation range from 8 to 63 years and males were more common. Road traffic accident is most common cause for defect at foot and ankle region followed by diabetic foot and orthopedic implant exposure. Most common site of defect in foot and ankle defect were dorsum of foot followed by lateral malleolus region. Free ALT flap cover performed most frequently followed by cross leg flap.Conclusion: Reverse sural flap is reliable option for small ankle and foot defect near ankle. Cross leg flap is also most reliable option for large defect in opposite healthy limb. Reverse saphanous flap also used for small defects on medial side ankle. Larger defect of ankle and foot can be covered by free fasciocutaneous or myocutaneous flaps where microsurgical expertise available.

Soft tissue reconstruction of foot and ankle defects with reverse sural fasciocutaneous flaps

ObjectiveThis study presents the results of 25 consecutive patients and evaluates the success of reverse sural fasciocuteneous flap (RSFF) on coverage of the foot and ankle region. MethodsA total of 25 patients with soft tissue defects in the lower leg, foot, or ankle were treated with RSFF, from January 2010 to January 2017. In the evaluation of patients, the form prepared by the clinic was used and the following data were collected: age, follow-up, gender, etiology, defect size, complications, and patient satisfaction rates. ResultsMean follow up time was 18 months. In all patients, the defects were fully covered. Three patients developed partial necrosis due to venous congestion. There was no complete flap loss in any of the patients. Patient satisfaction was excellent in all cases. ConclusionRSFF is quick, versatile, and easy to apply; it also provides safe soft tissue coverage, requires no microvascular repair, and provides an alternative to microsurgical reconstruction.

Versatility of the Reversed Superficial Peroneal Neurocutaneous Island Flap in the Coverage of Ankle and Foot

In the last decades, the skin island flap supplied by the vascular axis of sensitive superficial nerves, like the sural and saphenous nerves, has emerged as one of the most ideal reconstructive options for soft tissue coverage of lower limbs. The nutrient vessels of reversed superficial peroneal neurocutaneous island flap have been well described; however, it is still not commonly clinically applied. The aim of this study was to evaluate the efficacy of reversed superficial peroneal neurocutaneous island flap for coverage of ankle and foot. This is a retrospective and descriptive study of reversed superficial peroneal neurocutaneous island flap which was carried out for reconstruction of ankle and foot. This study was conducted at the Department of Repair and Reconstructive Surgery, the 6th People's Hospital affiliated to Shanghai Jiaotong University, during a period of 51 months from July 2008 to October 2012. A total of 12 patients with soft tissue defect of ankle and foot were included in the series; reversed superficial peroneal neurocutaneous island flap was performed on each case if relevant indications permitted. Preoperative and postoperative data of each patient, including etiology, size of defect, dimension of flap, complications, and functional and aesthetic results were noted. Among the 12 patients, there were 8 men and 4 women with an average age of 40.7 years (22-65 years) and with a mean follow-up time of 17.3 months (10-23 months). Most patients (11 patients) were posttraumatic. The size of the flap ranged from 48 to 108 cm2. Postoperatively, 11 flaps survived uneventfully, whereas marginal venous congestion was seen in the remaining patient, and secondary healing was achieved by conservative treatment. The reversed superficial peroneal neurocutaneous island flap could be an excellent alternative to other neurocutaneous perforator flap in the soft tissue reconstruction of foot and ankle.

Long-Term Sensation in the Medial Plantar Flap

INTRODUCTION: The glabrous plantar skin found on the foot and ankle is unique and perfectly adapted to weight bearing, limiting options for like-for-like tissue reconstruction in this region. Soft-tissue reconstruction of foot and ankle defects must be durable1 and provide sensation to prevent future injury.2 A sensate medial plantar fl ap can be raised from the non-weight bearing aspect of the sole and used to repair these defects, providing like-for-like tissue reconstruction whilst limiting donor site morbidity.3 This study aims to quantify sensation return when this versatile fl ap is used to repair foot and ankle defects. METHODS: Two-point discrimination in millimetres (2PD) was assessed in both flap and normal tissue of the contralateral foot in patients who had received a medial plantar flap over a year previously. The mean two-point discrimination in both flap and normal tissue was calculated and a paired T-test was used to assess for a significant difference between flap and normal tissue. RESULTS: 12 patients were eligible. 4 were excluded due to either 2PD in the normal tissue being larger than the flap (3 patients) or because testing was impossible due to hypersensitivity in the flap (1 patient). In the remaining 8, mean 2PD in the contralateral foot was 29mm (SD: 11.9) and mean 2PD in the flap was 33mm (SD: 9.97). No statistically significant difference in 2PD was found between flap and contralateral foot (two tailed p value: 0.1898). Mean age was 53.2 years (range 15-84). There was no statistically significant correlation between age and 2PD on the flap tissue (r=0.6, p=0.15) suggesting no worsening of sensation when this flap is utilised in older age groups. CONCLUSION: To the best of our knowledge this is the first case series to quantify long-term sensation return in medial plantar flaps used to repair foot and ankle defects. Our results suggest that after a year, sensation in the medial plantar flap can return to near normal. This demonstrates the important role the medial plantar flap plays in soft tissue reconstruction in this region.

Reverse lateral supramalleolar adipofascial flap and skin grafting for one‐stage soft tissue reconstruction of foot and ankle joint

The aim of this report is to present the clinical result and efficacy of reverse lateral supramalleolar adipofascial flap and skin grafting for one stage soft tissue reconstruction of the foot and ankle joints. Reconstruction using a reverse lateral supramalleolar adipofascial flap and skin grafting was performed in eight cases between January 2005 and March 2009. All the subjects were male with a mean age of 53 years. The mean follow-up period was 20 months. The reasons for soft tissue defects were diabetic foot, infected bursitis, open injuries of the foot, and chronic osteomyelitis. The mean size of the flaps was 3.5 (3-4) × 4.5 (4-6) cm. The flaps were elevated in the form of an adipofascial flap and split-thickness skin grafting was performed over the flaps and adjoining raw areas. Flaps survived in all cases. The implantation of the split-thickness skin graft over the flap was also successful in all cases. Neither partial necrosis in the adipofascial flap nor venous congestion was observed. At the last follow-up, there were no limited motions in the ankle and the toe. No cases complained of inconveniences in ambulation or had difficulties in selecting footwear. In cases that require a flap for the exposed bone or tendon of the foot with a small-sized defect, reverse lateral supramalleolar adipofascial flap and skin grafting is considered a useful method as it lowers the morbidity rate of the donor site and reconstructs soft tissues.

Comparison of Free Muscle and Perforator Skin Flaps for Soft Tissue Reconstruction of the Foot and Ankle

Free tissue transfer is generally required for reconstruction of soft-tissue defects of the foot and ankle region because of the limited local tissue available. This type of reconstruction may interfere with postoperative function and footwear if a bulky flap is used. Twenty-nine patients had free tissue transfers to the foot and ankle region during a period of 3 years. Sixteen had reconstruction with free anterolateral thigh perforator flaps (ALT) and 13 had reconstruction with free muscle flaps. The outcomes of both types of reconstructions were compared according to flap scores and complications, operative time, hospitalization, gait and shoewear problems. The patients in the ALT group were younger compared with those of the free muscle flap group (p = 0.022). The operative time and flap complication rate was significantly higher (p = 0.007 and 0.040, respectively) in the ALT group. ALT was generally used for reconstruction of the dorsal foot, heel and plantar regions. Muscle flaps were preferred in the ankle region, where open fractures of the tibia and fibula were frequently present, and for the patients with increased risk of perioperative morbidity. Free ALT flap consisting of skin and adaptable subcutaneous tissue, both diminishes donor site morbidity and is ideally suited for most soft-tissue reconstruction of the dorsal foot, heel and plantar foot. Free muscle flaps, however, may offer relatively less complicated tissue transfers and are preferred at the ankle region in the presence of open tibia fractures, and in high risk patients to decrease the perioperative morbidity.

Use of External Fixation for Soft Tissue Reconstruction of Foot and Ankle Wounds in the Non-Compliant Patient

Use of External Fixation for Soft Tissue Reconstruction of Foot and Ankle Wounds in the Non-Compliant Patient