Reconstruction of the foot with microvascular free flaps

Reconstruction of the foot using microvascular flaps has been widely performed in the last 15 years but the choice of flap to repair some areas in the foot remains controversial. We present a series of 128 free flaps to the foot performed during the period of 1975-1990. One hundred and seventeen had a successful outcome (91%). The etiology of the problem was traumatic in 94, congenital in 10, tumor in 9, and chronic ulcerations due to vascular problems in 15. The indications for a specific flap depended on the site and extension of the foot problem, and were divided into four groups: 1. Dorsum of the foot. Cutaneous parascapular flap was the best choice. 2. The sole-weight-bearing area. We favored the use of the latissimus dorsi muscle flap covered with a split thickness skin graft, done immediately. A proper tailoring of the flap and postoperative care by the patient are very important to maintain the result without ulceration. Tactile sensation does not seem to be essential. 3. The area over the calcaneus tendon. We have used cutaneous flaps such as the parascapular and lateral arm flap or fascial flaps covered by split thickness skin grafts (STSG). The fascia used were the serratus or the parascapular. 4. Complex trauma problems with extensive skin loss or chronic ulcerations due to vascular diseases: the latissimus dorsi musculocutaneous or muscle plus STSG was mostly used. The overall number of donor areas were 5 groins, 48 parascapular, 2 gluteal fold flaps, 4 lateral arm, 61 latissimus dorsi, and 8 fascial flaps.