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Medial plantar artery perforator and anterolateral thigh perforator flaps for complex forefoot reconstruction: A
Zhu Yue-Liang1, He Xiao-Qing2, Jiang Feng-Yi3
1Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Orthopedics Research Institute of Zhejiang University, Clinical Research Center of Motor System Disease of Zhejiang Province, Zhejiang Key Laboratory of Motor System Disease Precision Research and Therapy, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, Zhejiang 310009, China.
Background:
Soft-tissue coverage of the forefoot, especially for irregular and extensive skin defects, is challenging for reconstructive surgeons because of the complex biomechanical properties and the high sensitivity of the plantar region. In this study, the efficacy of a combined approach utilizing a medial plantar artery perforator flap (MPAPF) and an anterolateral thigh perforator flap (ALTPF) for complex forefoot reconstruction was evaluated.
Methods:
A retrospective case series was conducted. From May 2018 to October 2023, six patients with complex forefoot defects underwent reconstruction using both an MPAPF and an ALTPF. The cohort comprised four males and two females aged 19-67 years. Data on patient demographics, injury etiology, flap size and survival, time to initial weight-bearing, and restoration of protective sensation were analyzed using descriptive statistics.
Results:
All the flaps were free transplants, and no cases of vascular crisis were reported. MPAPF sizes ranged from 4.0 cm × 6.5 cm to 8.0 cm × 11.5 cm, whereas ALTPF sizes varied from 6.5 cm × 8.5 cm to 11.5 cm × 15.0 cm. During 8-27 months of follow-up, all patients achieved full weight-bearing within 3 months (mean 11.2 weeks). Protective sensation was restored in 83.3% (5/6) of the patients within 6 months and in the remaining 16.7% (1/6) of the patients within 8 months. The flaps exhibited good color and texture, and durable, sensitive coverage was observed in all the cases, with no recurrence of ulceration or major complications.
Conclusion:
The combined use of an MPAPF and ALTPF provides a feasible and promising strategy for complex forefoot reconstruction, resulting in reliable functional and sensory recovery with satisfactory aesthetic outcomes.
