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J Reconstr Microsurg 2001; 17(3): 147-150
DOI: 10.1055/s-2001-14344
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Radial Forearm Fasciocutaneous Free-Tissue Transfer in Ankle and Foot Reconstruction: Review of 17 Cases

Ramzi Musharafieh2 , Bishara Atiyeh1 , George Macari2 , Rachid Haidar2
  • 1Departments of Plastic and Reconstructive Surgery, Hand and Microvascular Surgery, American University of Beirut Medical Center, Lebanon and
  • 2Department of Orthopaedic Surgery, Hand and Microvascular Surgery, American University of Beirut Medical Center, Lebanon
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Publication Date:
31 December 2001 (online)

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ABSTRACT

Seventeen patients who underwent soft-tissue reconstruction of various anatomic regions of the foot and ankle, using the radial forearm fasiocutaneous free flap, are reported. The procedures were performed between January, 1992 and December, 1998. Indications for reconstruction included diabetes and/or vascular insufficiency (four patients), soft-tissue defects (six patients), and chronic osteomyelitis (seven patients). The weight-bearing surface of the foot was involved in 16 patients. Defects ranged in size from 35 to 206 cm2 (mean: 86.2 cm2). At a mean follow-up of 3.8 years, the radial forearm flap was successful in all cases (100 percent). Flap complications included superficial infection (three patients), and minor wound dehiscence at the flap-leg-skin interface (two patients). Recurrent ulceration occurred in two patients; both were diabetics with weight-bearing flaps. Donor-site complications included partial skin graft loss with tendon exposure in one patient, which healed with conservative management. Recurrent or persistent osteomyelitis was not demonstrated in any of the patients. Of the 16 patients with weight-bearing flaps, 12 were ambulatory, three had limited ambulation, and one was non-ambulatory. Three patients required modified shoes. No debulking of the transferred flaps was necessary.

The radial forearm flap is one of the preferred flaps for reconstruction of moderate-sized ankle and foot defects, for weight-bearing surfaces, and in the treatment of osteomyelitic and diabetic wounds. It meets most of the anatomic prerequisites for an ideal foot coverage; it also facilitates the restoration of normal foot contour, allowing patients to wear ordinary shoes. The flap provides a durable and stable weight-bearing plantar surface during ambulation, and achieves excellent aesthetic results; when used as a neurosensory flap, it permits adequate reinnervation.

KEYWORD

Soft tissue defects - foot reconstruction - radial - forearm - fasciocutaneous free-tissue transfer