[Reconstruction of complex foot defects by serratus anterior-rib osteomuscular free flap: about four cases]

The foot is a region of the lower limb presenting some functional and aesthetic particularities. Free flap surgery is often indicated in complex traumatic foot defects (bony and soft tissue) of the foot. In this kind of trauma, we prefer to use the serratus anterior-rib free flap. We report four cases with this technique while analyzing the long-term functional aspects of the reconstruction.

We have reviewed four cases treated from 2008 to 2010. These patients have been reexamined recently in order to judge the functional and aesthetic aspects of this reconstructive technique.

The mean age of our patients was 50 years and 3 months. The defect concerned the metatarsal bones in three cases and the calcaneus in one case. The soft tissue defect measured a mean of 60 cm(2) and the bony defect 5.75 cm. Our current mean follow-up is of 4 years and 3 months and only one of four patients needs occasionally one crutch for walking.

The serratus anterior-rib flap is well suited for the foot region because of the length of its pedicle, the quality and the thinness of the obtained muscular coverage. The possibility of a synchronous bony reconstruction is a major advantage thus permitting an all-inclusive treatment.