J reconstr Microsurg 2019; 35(05): 379-388
DOI: 10.1055/s-0038-1677038
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Microsurgical Reconstruction of the Plantar Foot: Long-Term Functional Outcomes and Quality of Life

Paul I. Heidekrueger
1  Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
,
Denis Ehrl
2  Department for Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
,
Lukas Prantl
1  Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
,
Aung Thiha
1  Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
,
Fabian Weinschenk
3  Department for Plastic, Reconstructive, Hand, and Burn Surgery, Technical University Munich, StKM - Klinikum Bogenhausen, Academic Teaching Hospital, Munich, Germany
,
Antonio J. Forte
4  Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida
,
Milomir Ninkovic
3  Department for Plastic, Reconstructive, Hand, and Burn Surgery, Technical University Munich, StKM - Klinikum Bogenhausen, Academic Teaching Hospital, Munich, Germany
,
P. Niclas Broer
3  Department for Plastic, Reconstructive, Hand, and Burn Surgery, Technical University Munich, StKM - Klinikum Bogenhausen, Academic Teaching Hospital, Munich, Germany
› Author Affiliations
Funding None.
Further Information

Publication History

19 April 2018

11 November 2018

Publication Date:
09 January 2019 (eFirst)

Abstract

Background When faced with plantar defects, reconstruction of the weight-bearing areas presents unique surgical challenges. Several free flap modalities have been described in this respect, but there remains debate regarding the best-suited flap modality. Aim of this study was to compare free muscle and non-neurotized fasciocutaneous flaps for plantar reconstruction with respect to long-term functional outcomes.

Methods Overall, 89 patients received 100 free flaps (anterolateral thigh [ALT] n = 46; gracilis n = 54) for plantar reconstruction. The data were screened for patients' demographics, as well as perioperative details. Postoperative complications were accounted for and the two groups compared accordingly. All patients were contacted for a long-term follow-up examination.

Results There were no significant differences between the two groups regarding major (24 vs. 17%; p = 0.366) and minor surgical complications (61 vs. 70%; p = 0.318). However, the ALT group showed a significantly higher need for secondary surgeries (39 vs. 19%; p = 0.022). Sixty-eight patients (76%) returned for long-term follow-up evaluation (mean: 51.2 months, range: 13–71 months). The ALT group showed significantly less pain at the recipient (p = 0.0004) and donor (p = 0.010) sites, and scar assessment revealed significantly better results (p < 0.001). Additionally, the ALT group showed better depth (p = 0.017) and superficial (p = 0.007) sensation and enabled better shoe provision (p = 0.014).

Conclusion Both the free ALT and gracilis flaps are well suited for plantar reconstruction, yielding overall similar functional outcomes. However, the ALT flap produces less scarring and pain, while showing better recovery of sensation and enabling better shoe provision. The ALT flap thus presents our preferred option.