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Traumatic Forefoot Reconstructions With Free Perforator Flaps.

Yue-Liang Zhu1, Xiao-Qing He1, Yi Wang1

  • 1Surgeon, Orthopaedic Department, Kunming General Hospital of Chengdu Military Region, Kunming, China.

The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons
|July 21, 2015
PubMed
Summary

Free perforator flaps offer excellent functional and cosmetic outcomes for forefoot reconstruction after trauma. Thorough debridement is key to success, improving weight-bearing and gait compared to other flap methods.

Keywords:
flapforefootinjuryplastic and reconstructive surgerytissue loss

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Area of Science:

  • Plastic and Microsurgery
  • Reconstructive Surgery
  • Orthopedic Surgery

Background:

  • The forefoot is crucial for normal ambulation, necessitating meticulous reconstruction of soft tissue defects.
  • Free perforator flaps are theoretically ideal for forefoot reconstruction due to their vascularity and minimal donor site morbidity.
  • However, their complexity can be a barrier in reconstructive procedures.

Observation:

  • This study evaluated the use of five types of free perforator flaps in 41 patients with traumatic forefoot defects.
  • The primary surgical technique involved thorough debridement of devitalized tissue before flap attachment.
  • Outcomes were assessed based on functional, cosmetic, weight-bearing, and gait parameters.

Findings:

  • Overall functional and cosmetic results were excellent across all flap types.
  • Three flaps required re-exploration, with one ultimately surviving.
  • Common complications included initial insufficient perfusion and the need for secondary debulking procedures.

Implications:

  • Thorough debridement of necrotic tissue is paramount for successful free perforator flap outcomes in forefoot reconstruction.
  • Free perforator flaps demonstrate superior functional and aesthetic results compared to alternative flap techniques previously used.
  • This reconstructive approach enhances patient weight-bearing capacity and improves gait mechanics post-trauma.