Tendocutaneous free flap transfer from the dorsum of the foot

Tendocutaneous free flap transfer has been used to treat troublesome wounds involving skin and tendons, with the dorsum of the foot being the most frequent donor site. Free flaps consist of the dorsalis pedis artery, saphenous vein, branch of the superficial peroneal nerve, long extensor tendons, and overlying skin. We analyzed 13 cases of skin and tendon loss from the dorsum of the hand and wrist that were treated with tendocutaneous free flap from the dorsum of the foot. The size of the flap was from 6 x 5 cm to 11.5 x 7.1 cm (average, 9.2 x 5.9 cm), and the transferred tendons ranged from 1 to 5 in number (average, 2.9), and 5 to 17 cm in length (average, 9.2 cm). The transferred flaps survived in all cases, and the transferred tendons were functioning well except in two cases of electrical burn. The complications included two cases of tendon adhesion, one case of marginal necrosis of the flap, and three cases of donor-site wound problem.