A Case Report of a Double Advancement Flap Closure Combined With an Ilizarov Technique for the Chronic Plantar Forefoot Ulceration

Abstract

Soft tissue closure of defects on the plantar surface of the foot continues to be a challenge for the reconstructive surgeon secondarily to the limited number of surgical options and often difficulty of replacing durable and similar soft tissue coverage. Primary closure and skin grafting may not be suitable for the weight-bearing surfaces of the plantar forefoot area, and closure may then be obtained by other means of plastic surgery techniques.

Combined Midfoot Arthrodesis, Muscle Flap Coverage, and Circular External Fixation for the Chronic Ulcerated Charcot Deformity

“…The use of circular external fixation as an adjunct for this type of reconstruction is invaluable for many reasons. 16 When the FDB muscle flap is performed, external fixation is crucial to offload the muscle flap and prevent accidental trauma to the soft tissue coverage and osseous correction. In addition, external fixation allows for frequent monitoring of flap vascularity and access for necessary dressing changes.…”

“…In addition, external fixation allows for frequent monitoring of flap vascularity and access for necessary dressing changes. 16 Furthermore, external fixation joint compression techniques can be used to assist with lateral column exostectomy or arthrodesis. Application of external fixation is contraindicated in acutely infected ulcers and in patients with psychiatric illness or a history of noncompliance.…”

Use of Local Flaps for Soft-Tissue Closure in Diabetic Foot Wounds: A Systematic Review

“…The initial search identified 53 eligible studies. 4-56 After applying the inclusion and exclusion criteria, 28 studies were excluded. Nine studies were excluded because they were performed on foot wounds in patients without diabetes mellitus *.…”

Soft Tissue Reconstruction Pyramid in the Diabetic Foot

“…Modifications of bilobed 43 and V-Y random advancement flaps have been described for the coverage of submetatarsal ulcers and plantar defects, as long as no underlying osteomyelitis is present. [44][45][46][47] In addition, toe fillet flaps may be applied to partial foot or ray amputations when the associated soft tissue defect precludes primary closure. [48][49][50] The toe fillet flap involves amputation of the skeletal and nail matrix components of a digit with preservation of the surrounding digital skin and soft tissue.…”