Innervated free flaps for foot reconstruction: a review

Area of Science:

• Microsurgery
• Reconstructive Surgery
• Podiatric Medicine

Background:

• Reconstruction of the plantar foot surface is a common surgical challenge.
• Previous reviews on sensate plantar weight-bearing flaps are over a decade old.
• Current emphasis on outcome analysis necessitates a re-evaluation of flap techniques.

Purpose of the Study:

• To review and analyze published literature on plantar foot reconstruction using flaps.
• To determine if innervated flaps are critical for the durability and ambulation of the weight-bearing foot.
• To identify optimal flap types (local, regional, distant) and nerve sources for reconstruction.

Main Methods:

• Systematic review of peer-reviewed literature on plantar foot reconstruction.
• Analysis of flap characteristics: location, innervation status, and donor/recipient nerve identification.
• Evaluation of outcomes: sensibility, ulceration rates, and activities of daily living.

Main Results:

• The critical role of innervated flaps for weight-bearing foot durability and ambulation remains undetermined.
• Recommendations include blocking original nerves before flap harvest to ensure intended nerve inclusion.
• Specific donor nerves are suggested for different foot regions: calcaneal nerve for heel, plantar branches for arch/forefoot.

Conclusions:

• Evidence is insufficient to definitively state that innervated flaps are essential for weight-bearing foot reconstruction.
• Strategic nerve selection and flap design are crucial for optimizing reconstructive outcomes.
• Further research is needed to ascertain the long-term benefits of sensory nerve reinnervation in muscle flaps for foot reconstruction.