Resurfacing and sensory recovery of the sole

(1) There is very little quantitative objective information on sensory recovery after resurfacing of the sole. However, based on results obtained by quantitative rather than qualitative methods to measure sensibility, there is little reason to expect a high level of sensory recovery, at least in free flaps. There is no evidence to prove or refute that by using neurosensory flaps or other forms of neurotization, a higher level of sensibility can be achieved, and therefore no reason why such a flap should be specifically selected when reconstructing the sole. Also, the sensibility of the flap has not been shown to be related to the soft-tissue stability after resurfacing of traumatic defects. (2) There are no firm guidelines to flap selection. If possible, a local flap should be selected. If a free-tissue transfer is necessary, a safe choice is for the surgeon to select a familiar flap with a long pedicle of sufficient caliber. The flap should be well tailored into the defect, and excessively thick flaps should be avoided. If in doubt, the donor area can be measured with ultrasonography and compared with the depth of the defect. Muscle flaps should be used to cover deep, irregular, or infected defects, whereas skin flaps are suitable for resurfacing superficial degloving tissue loss. (3) The most important reason for recurrent breakdowns after reconstruction may be abnormally high pressure points in the sole. Bony deformities should be identified preoperatively and removed during the operation. Patient education in meticulous foot care and custom-made insoles or footwear should be provided to prevent reulcerations. (4) The ideal method of resurfacing of the sole would also provide normal sensibility to the skin. With free-flap transfer this cannot be achieved with current techniques. Before new methods of neural reconstruction can be recommended for general use, their efficacy in improving sensibility should be documented by prospective studies using quantitative methods of measurement. If a reduction of breakdowns is claimed, biomechanical studies should be employed to exclude this being merely due to elimination of abnormal pressure points in the sole.