Overcoming the weight of reconstruction-anterolateral thigh flap reconstructions of the weight-bearing surface within the foot. Outcome assessment using foot function index.

PURPOSE: Weight-bearing region among the plantar surface of the foot is critical for proper functioning of the lower limb and serves as a point of resistance and support for the weight of the whole body. However, when foot injury is more complex as well as involves exposure of bones, tendons or joints-the adequate soft tissue coverage is needed to facilitate healing and prevent future cutaneous fistulas. Free flaps meet all of these criteria and with current advances within the field of microsurgery-it is not disfiguring, nor does it bring any additional burden to the patient.

METHODS

Informations concerning extensive plantar reconstructions in adolescent patients, using free fasciocutaneous flaps were gathered retrospectively by the authors. The mean follow-up was 47 months. To examine the functional outcome-all patients patient were assessed using foot function index (FFI).

RESULTS

In all cases soft tissue coverage of the defect and appropriate function were provided. No postoperative complications were reported apart from minor pressure ulcer which was treated conservatively. The mean FFI score was 8.9%, which is considered as a very good functional outcome. No patient reported cutaneous fistulas in the late postoperative period.

CONCLUSIONS

Reconstructions of the weight-bearing surface of the foot with anterolateral thigh free flaps provide durable and functionally satisfactory outcome. However, in some cases they may require flap adjustment in the second surgical procedure, to fit the healthy, untreated foot. In all cases, the outcome was fully accepted both by young patients as well as their parents.