Microsurgical reconstruction of wide simple and compound foot defects

A mutilated foot as a result of traumas or resection for tumours or ulcers, is a serious physical and social handicap for the patient, because it impairs deambulation and affects his selfgovernment. The evolution of microsurgical techniques has allowed us to utilize such methods to reconstruct wide simple and composite losses of substance of the foot, usually treated conservatively or radically with amputation and prosthesization. Functional, cosmetic and social outcome has been evaluated.

We evaluated 23 patients affected by cutaneous (19) and osteocutaneous (4) losses of substance of the foot (11 of rearfoot, 5 of forefoot, 4 of the sole, 1 of middlefoot, 1 of the dorsum, and 1 of the malleolus). We performed 23 microsurgical reconstructions harvesting 24 free flaps (14 radial flaps, 4 latissimus dorsi, 3 fibula, 1 scapular flap, 1 lateral arm, 1 iliac crest).

Cutaneous and muscular flaps healed in 3 weeks, while osteocutaneous flaps healed in 10 to 12 weeks. Deambulation was restored in all patients but 1, within 6 months from surgery, and all patients went back to their work and social life. We observed in the early follow-up 2 cases of partial skin necrosis, which solved spontaneously and 1 case of total necrosis (overall complication = 4.3%). Donor area morbidity was rated as fair. Overall success rate was 95.7% at a mean follow-up of 3 years.

Free microsurgical transfers allowed us to obtain a satisfactory and long-lasting morpho-functional restoration of wide superficial and deep losses of substance of the foot, guaranteeing the patient a fast psycho-physical and social rehabilitation.