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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
› Institutsangaben Funding None.
Weitere Informationen

Publikationsverlauf

19. April 2018

11. November 2018

Publikationsdatum:
09. Januar 2019 (online)

    Lizenzen und Reprints

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.

Keywords

plantar reconstruction - sole reconstruction - weight-bearing area
 

  • References

  • 1 Harris PG, Letrosne E, Caouette-Laberge L, Egerszegi EP. Long-term follow-up of coverage of weight bearing surface of the foot with free muscular flap in a pediatric population. Microsurgery 1994; 15 (06) 424-429
    CrossrefPubMedGoogle Scholar
  • 2 Sakai S. A distally based island first dorsal metatarsal artery flap for the coverage of a distal plantar defect. Br J Plast Surg 1993; 46 (06) 480-482
    CrossrefPubMedGoogle Scholar
  • 3 Emmett AJ. The filleted toe flap. Br J Plast Surg 1976; 29 (01) 19-21
    CrossrefPubMedGoogle Scholar
  • 4 Granick MS, Newton ED, Futrell JW, Hurwitz D. The plantar digital web space island flap for reconstruction of the distal sole. Ann Plast Surg 1987; 19 (01) 68-74
    CrossrefPubMedGoogle Scholar
  • 5 Koshima I, Urushibara K, Inagawa K, Hamasaki T, Moriguchi T. Free medial plantar perforator flaps for the resurfacing of finger and foot defects. Plast Reconstr Surg 2001; 107 (07) 1753-1758
    CrossrefPubMedGoogle Scholar
  • 6 Oh SJ, Moon M, Cha J, Koh SH, Chung CH. Weight-bearing plantar reconstruction using versatile medial plantar sensate flap. J Plast Reconstr Aesthet Surg 2011; 64 (02) 248-254
    CrossrefPubMedGoogle Scholar
  • 7 Beidas OE, Tan BK, Petersen JD. The rotational advancement of medial plantar flap for coverage of foot defect: a case report. Microsurgery 2012; 32 (04) 322-325
    CrossrefPubMedGoogle Scholar
  • 8 Scheufler O, Kalbermatten D, Pierer G. Instep free flap for plantar soft tissue reconstruction: indications and options. Microsurgery 2007; 27 (03) 174-180
    CrossrefPubMedGoogle Scholar
  • 9 Morrison WA, Crabb DM, O'Brien BM, Jenkins A. The instep of the foot as a fasciocutaneous island and as a free flap for heel defects. Plast Reconstr Surg 1983; 72 (01) 56-65
    CrossrefPubMedGoogle Scholar
  • 10 Zukowski M, Lord J, Ash K, Shouse B, Getz S, Robb G. The gracilis free flap revisited: a review of 25 cases of transfer to traumatic extremity wounds. Ann Plast Surg 1998; 40 (02) 141-144
    CrossrefPubMedGoogle Scholar
  • 11 Franco MJ, Nicoson MC, Parikh RP, Tung TH. Lower extremity reconstruction with free gracilis flaps. J Reconstr Microsurg 2017; 33 (03) 218-224
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 12 Engel H, Lin CH, Wei FC. Role of microsurgery in lower extremity reconstruction. Plast Reconstr Surg 2011; 127 (Suppl. 01) 228S-238S
    CrossrefPubMedGoogle Scholar
  • 13 Rodriguez ED, Bluebond-Langner R, Copeland C, Grim TN, Singh NK, Scalea T. Functional outcomes of posttraumatic lower limb salvage: a pilot study of anterolateral thigh perforator flaps versus muscle flaps. J Trauma 2009; 66 (05) 1311-1314
    CrossrefPubMedGoogle Scholar
  • 14 Yazar S, Lin CH, Lin YT, Ulusal AE, Wei FC. Outcome comparison between free muscle and free fasciocutaneous flaps for reconstruction of distal third and ankle traumatic open tibial fractures. Plast Reconstr Surg 2006; 117 (07) 2468-2475 , discussion 2476–2477
    CrossrefPubMedGoogle Scholar
  • 15 Sinha AK, Wood MB, Irons GB. Free tissue transfer for reconstruction of the weight-bearing portion of the foot. Clin Orthop Relat Res 1989; (242) 269-271
    PubMedGoogle Scholar
  • 16 Kuran I, Turgut G, Bas L, Ozkan T, Bayri O, Gulgonen A. Comparison between sensitive and nonsensitive free flaps in reconstruction of the heel and plantar area. Plast Reconstr Surg 2000; 105 (02) 574-580
    CrossrefPubMedGoogle Scholar
  • 17 May Jr JW, Halls MJ, Simon SR. Free microvascular muscle flaps with skin graft reconstruction of extensive defects of the foot: a clinical and gait analysis study. Plast Reconstr Surg 1985; 75 (05) 627-641
    CrossrefPubMedGoogle Scholar
  • 18 Noever G, Brüser P, Köhler L. Reconstruction of heel and sole defects by free flaps. Plast Reconstr Surg 1986; 78 (03) 345-352
    CrossrefPubMedGoogle Scholar
  • 19 Sönmez A, Bayramiçli M, Sönmez B, Numanoğlu A. Reconstruction of the weight-bearing surface of the foot with nonneurosensory free flaps. Plast Reconstr Surg 2003; 111 (07) 2230-2236
    CrossrefPubMedGoogle Scholar
  • 20 Sommerlad BC, McGrouther DA. Resurfacing the sole: long-term follow-up and comparison of techniques. Br J Plast Surg 1978; 31 (02) 107-116
    CrossrefPubMedGoogle Scholar
  • 21 Scaglioni MF, Rittirsch D, Giovanoli P. Reconstruction of the heel, middle foot sole, and plantar forefoot with the medial plantar artery perforator flap: clinical experience with 28 cases. Plast Reconstr Surg 2018; 141 (01) 200-208
    CrossrefPubMedGoogle Scholar
  • 22 Löfstrand JG, Lin CH. Reconstruction of defects in the weight-bearing plantar area using the innervated free medial plantar (Instep) flap. Ann Plast Surg 2018; 80 (03) 245-251
    CrossrefPubMedGoogle Scholar
  • 23 Fischer JP, Wink JD, Nelson JA. , et al. A retrospective review of outcomes and flap selection in free tissue transfers for complex lower extremity reconstruction. J Reconstr Microsurg 2013; 29 (06) 407-416
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 24 Xiong L, Gazyakan E, Kremer T. , et al. Free flaps for reconstruction of soft tissue defects in lower extremity: a meta-analysis on microsurgical outcome and safety. Microsurgery 2016; 36 (06) 511-524
    CrossrefPubMedGoogle Scholar
  • 25 Cho EH, Shammas RL, Carney MJ. , et al. Muscle versus fasciocutaneous free flaps in lower extremity traumatic reconstruction: a multicenter outcomes analysis. Plast Reconstr Surg 2018; 141 (01) 191-199
    CrossrefPubMedGoogle Scholar
  • 26 Miller TJ, Jeong HS, Davis K. , et al. Evaluation of the American Society of Anesthesiologists Physical Status classification system in risk assessment for plastic and reconstructive surgery patients. Aesthet Surg J 2014; 34 (03) 448-456
    CrossrefPubMedGoogle Scholar
  • 27 Hong JP, Shin HW, Kim JJ, Wei FC, Chung YK. The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity. Plast Reconstr Surg 2005; 115 (01) 142-147
    PubMedGoogle Scholar
  • 28 Salgado CJ, Mardini S, Jamali AA, Ortiz J, Gonzales R, Chen HC. Muscle versus nonmuscle flaps in the reconstruction of chronic osteomyelitis defects. Plast Reconstr Surg 2006; 118 (06) 1401-1411
    CrossrefPubMedGoogle Scholar
  • 29 Guzman-Stein G, Fix RJ, Vasconez LO. Muscle flap coverage for the lower extremity. Clin Plast Surg 1991; 18 (03) 545-552
    CrossrefPubMedGoogle Scholar
  • 30 Yaremchuk MJ. Acute management of severe soft-tissue damage accompanying open fractures of the lower extremity. Clin Plast Surg 1986; 13 (04) 621-632
    CrossrefPubMedGoogle Scholar
  • 31 Francel TJ, Vander Kolk CA, Hoopes JE, Manson PN, Yaremchuk MJ. Microvascular soft-tissue transplantation for reconstruction of acute open tibial fractures: timing of coverage and long-term functional results. Plast Reconstr Surg 1992; 89 (03) 478-487 , discussion 488–489
    CrossrefPubMedGoogle Scholar
  • 32 Heidekrueger PI, Heine-Geldern A, Ninkovic M, Herter F, Mueller C, Broer PN. Extending the limits of microsurgical reconstruction in patients with moderate to very severe obesity: single-center 6-year experiences. J Reconstr Microsurg 2017; 33 (02) 124-129
    Artikel in Thieme ConnectPubMedGoogle Scholar