Sensory Recovery of Foot and Ankle Reconstruction with Neurotized ALT Flaps: A Systematic Review

The anterolateral thigh flap (ALT) is a reliable soft tissue reconstruction option, especially for lower extremity defects. Recent advancements in flap innervation methods show promise in promoting sensory recovery, yet the current literature lacks a comprehensive summary of its outcomes.

A systematic review of PubMed, Embase, Web of Science, and Scopus was performed by identifying all studies examining sensory recovery outcomes in lower extremity reconstruction using innervated ALT flaps.

Of 793 unique articles, eight studies (n = 206 patients) met the inclusion criteria. The mean age was 47.9 ± 11.1 (range: 6-80). The most common etiologies of soft tissue defect were trauma (n = 94, 45.6%), diabetic foot ulcers (n = 64, 31.1%), and malignancy (n = 45, 21.8%). There were 108 (52.4%) patients who underwent reconstruction with a neurotized ALT flap, and 98 (47.6%) without. Of patients with neurotized flap reconstruction, nerve coaptation was performed end-to-end (n = 31, 28.7%) or end-to-side (n = 14, 12.9%). Recipient nerves included the medial plantar (n = 16, 14.8%), medial dorsal cutaneous (n = 9, 8.3%), calcaneal (n = 7, 6.5%), posterior tibial (n = 5, 4.6%), superficial peroneal (n = 4, 3.7%), or sural (n = 1, 0.9%) nerves. The overall complication rate was 16.5%, of which 11 (5.3%) were major flap complications requiring a return to the operating room. Overall, three studies found evidence of improved sensory recovery when using neurotized ALT flaps.

Lower extremity reconstruction with innervated ALT flaps predominantly involves the foot and ankle region (98.5%), as the improved sensory recovery may be helpful in reducing secondary injury risk, such as diabetic foot ulcers. No cases involving reconstruction of soft tissue defects above the knee were identified.