Elsevier

The Journal of Foot and Ankle Surgery

Volume 53, Issue 6, November–December 2014, Pages 727-734
The Journal of Foot and Ankle Surgery

Original Research
Free and Pedicled Flaps for Reconstruction of the Weightbearing Sole of the Foot: A Comparative Analysis of Functional Results

Parts of our report were orally presented at the Annual Meeting of the German Society of Plastic, Reconstructive and Aesthetic Surgery, September 2012, Bremen, Germany, and at the Annual Meeting of the German Society of Surgery, May 2013, Munich, Germany.
https://doi.org/10.1053/j.jfas.2014.06.009Get rights and content

Abstract

Reconstruction of the weightbearing sole of the foot is complex and requires soft tissue that is resistant to weight, pressure, and shear stress. Despite a variety of flap types and techniques, it is still challenging to meet these demands. The present retrospective study included 21 patients after reconstruction of plantar tissue defects from 2001 to 2011. The outcome was evaluated using the lower extremity functional scale, Weber score, pedobarography, assessment of shifting, and sensory recovery. The patients' quality of life was documented using the SF-36 questionnaire. Plantar reconstruction was performed using 12 free and 9 pedicled flaps. No differences in functional results were observed between the flap types, despite a better sense of temperature in the adipocutaneous flaps. The extent of flap shifting was independent of the flap type and did not correlate with the functional results. Pedobarography showed a tendency for increased peak pressure and prolonged contact time in the reconstructed weightbearing plantar areas compared with the sound feet and a control group. The present study found no relevant differences in the functional results between different flap types and free or pedicled techniques. Flap selection should be based on the individual requirements and availability of donor sites.

Section snippets

Patients and Methods

The present retrospective study included 37 patients treated for defects in the weightbearing plantar area with either free or pedicled flaps from 2001 to 2010 in our clinic. These flaps were performed in 37 patients during the study period. After analyzing the medical history, we excluded 9 of the 37 patients because of death (n = 1), major amputation (n = 2), multidrug resistant bacteria infection (n = 2), and immobility (n = 4). In addition, 4 patients were lost to follow-up, and 3 refused

Results

In the present study, 12 free and 9 pedicled flap reconstructions were performed (Table 1 and Fig. 2). Of those, 13 were fasciocutaneous, 4 adipocutaneous, 2 myofasciocutaneous, and 2 were muscle flaps with split-thickness skin grafts (Fig. 3). None of the free flaps was transferred with sensory nerve coaptation.

No complete flap loss was seen. One medial plantar artery flap required revision because of hematoma. Most of the defects had been caused by trauma and were located in the heel region (

Discussion

In the recent medical data, the different approaches concerning the best flap types for reconstruction of the weightbearing sole of the foot and necessity for reinnervation have been controversial. Owing to the low number and heterogeneity of these patients, it would be very difficult to design a prospective study. Follow-up studies that have included pedobarographic gait analyses are rare. Perttunen et al (15) examined 7 patients, and Meyer-Marcotty et al (16) examined 8 patients. Both studies

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    Conflict of Interest: None reported.

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