Free vascularized soft tissue flaps for coverage of the foot and ankle

Microsurgical procedures for coverage of foot and ankle defects now are undertaken with a better understanding of biomechanical requirements, and concern for durability, aesthetics, donor site morbidity, and shoe fit. Well-contoured muscle flaps including the latissimus dorsi, rectus abdominis, and gracilis muscles frequently are used along with thin cutaneous flaps, especially from the lateral arm. When good local options are absent and exposed nerves, tendons, and bone, and surgical hardware are present, acute free flaps and delayed primary procedures are done frequently with excellent success rates (> 90%). Surgical adjuncts and pedorthic devices are used readily to enhance functional outcomes and to resolve shoe fitting and tissue breakdown problems. Free tissue transfers for foot and ankle coverage defects have reached state-of-the-art status, having been refined significantly to resolve many earlier problems.