[Surgical reconstruction of post-traumatic tissue loss of the weight-bearing sole of the foot].

The repair of the weight bearing zones of the foot is a difficult problem for which an ideal solution does not exist. The contribution of pedicled flaps and free flaps allows it nevertheless to obtain reconstructions of good quality, which are however prone to mechanical complications. The pedicled flaps most commonly used are the instep island flap, the lateral supra-malleolar flap and the cross-leg flap. Among the free flaps figure the latissimus dorsi flap, the forearm flap and the free scapular flap. The sensitivity of the flap does not seem to be a decisive advantage if the receptor region is normally innervated and of good trophic quality. On the contrary, a sensible flap becomes necessary on a foot with neurological complications or extensive skin complications. About 15 years ago, the introduction of technical procedures on the basis of vascularised flaps has considerably modified the indications for the treatment of substance losses of the foot in the weight bearing zone. It is advisable from the beginning to distinguish radically between feet with normal sensibility and feet which are insensible owing to peripheral nerve lesions. We have excluded on principle those cases where the nerve lesion is of congenital origin or secondary to a nontraumatic affection. We will deal successively with the problems due to the localisation of the substance loss, the possible surgical techniques, the indications, and the complications.