Reconstruction of traumatic forefoot defects with free lateral arm flap

This study aims to evaluate the results of traumatic soft tissue defects of the forefoot reconstructed using the lateral arm flap and to examine the advantages and disadvantages of this flap.

Between January 2007 and December 2023, a total of 25 patients (23 males, 2 females; median age: 35 years; range, 8 to 57 years) who underwent lateral arm free flap reconstruction for forefoot soft tissue defects were retrospectively analyzed. Age, sex, injury mechanism, flap size, anastomosis site, vascular complications, associated injuries, functional results, donor site coverage, and aesthetic results of the operation rated by the patient and surgeons were noted. The recovery of sensation at the reconstructed site was also evaluated.

The median follow-up was 24.8 (range, 15 to 44) months. Only one total flap loss was encountered in this study, with an overall flap survival rate of 96%. Debulking of the flap was necessitated in four patients for comfortable shoe wear; those flaps were used to cover sizeable dorsal defects of the foot. The median European Foot and Ankle Society (EFAS) daily living score at the final evaluation was 18.2 (range, 17 to 21). All patients were able to wear regular shoes without modifications. All flaps regained protective sensation, although in none of them a neurography was performed. In the Semmes-Weinstein monofilament (SWM) testing, 18 patients could feel 4.56, four patients 6.65, and three patients 4.31. The patient-rated satisfaction score for reconstruction averaged 3,7 on a five-point scale.

Reconstruction of forefoot soft tissue defects using the lateral arm flap provided satisfactory results in terms of successful soft tissue coverage, function, and patient satisfaction, with good cosmetic appearance and unrestricted shoe wear. Based on these findings, this flap is a good alternative for forefoot reconstruction owing to its ease of dissection, constant vascular anatomy, rich blood supply, and limited thickness. In addition, it does not sacrifice a major artery, does not limit the function of the arm, and the donor site can be closed primarily in most cases. The main disadvantage of the flap seems to be the conspicuous scar it leaves on the lateral aspect of the arm.