Free tissue transfer for reconstruction of the weight-bearing portion of the foot

Twenty-eight patients treated with free tissue transfer for soft-tissue coverage of the weight-bearing portion of the foot were investigated over a minimum follow-up period of 12 months. Seven were treated with a sensory innervated flap transfer, and 21 had a noninnervated skin or muscle flap transfer. Secondary procedures to debulk or sculpture the flap were necessary in seven patients. Complications occurred in six patients and were either related to lack of protective sensibility (in three) or excessive flap mobility (in three). Impaired flap sensibility was more common in noninnervated flaps, but excessive flap mobility was more typical of cutaneous flaps. The merits of an innervated cutaneous flap, which may be excessively bulky, must be weighed against those of a well-contoured muscle flap without sensory innervation.