Comparison between Sensitive and Nonsensitive Free Flaps in Reconstruction of the Heel and Plantar Area

Abstract

In this study, 12 cases of reconstruction of the heel and plantar area since 1982 are reviewed. Six nonsensate muscle free flaps and six sensate fasciocutaneous flaps were used, respectively. Categories assessed were the time interval for return to daily living activities, sensation to light touch, pinprick, Semmes-Weinstein monofilament test of the reconstructed area for sensory evaluation; and results of pedograms (maximal pressure, pressure distribution, and total contact area of the plantar surface). Follow-up periods were between 2 and 14 years, with an average of 6 years. Better sensory results and early return to daily living activities were observed in the sensate flap group, but the defects were smaller in this group. Despite the slightly longer time to return to daily living activities and worse sensory results, long-term follow-up showed that patients with nonsensate flaps had no difficulty in performing living activities if they continued to be careful and to use some kind of protective shoes. The results of the pedogram analyses were similar between the two groups with regard to total contact area of the reconstructed foot in relation to the healthy foot. Pressure values of the reconstructed areas in sensate flaps were found to be close to pressure values in the same weight areas of the normal foot. The differences between pressure values of the sensate and nonsensate flaps were statistically significant (p < 0.001). Therefore, in reconstruction of the weight-bearing surface of the foot, each case should be evaluated individually. The reconstructive method should be chosen according to the location and soft-tissue requirements of the defect.

Colgajo sural reverso neurotizado en el tratamiento de úlcera postraumática del talón

“…Kuran y col. compararon los colgajos libres sensitivos y no sensitivos en la reconstrucción plantar y del mandan tiempos quirúrgicos prolongados y suponen una mayor morbilidad; para lograr excelentes resultados necesitan de un entrenamiento especializado, no sólo del cirujano, sino de todo el equipo quirúrgico, cuidados postoperatorios estrechos y centros quirúrgicos con equipos específicos (3,9,10).…”

“…El colgajo sural reverso realizado en este caso proporcionó la adecauda cobertura del defecto, con las dimensiones y el grosor necesarios para poder soportar la presión, las cuales según Kuran y col. se acercan a los valores de presión y superficie de contacto del pie normal contralateral cuando se utilizan colgajos neurosenstivo (9). Es por ello que decidimos no solo realizar la cubierta cutánea del defecto del talón, ya que se necesitaba también sensibilidad para poder ejercer una marcha segura y reducir la posibilidad de una nueva ulceración de la piel.…”

“…4-6). talón, observando que el grupo de pacientes tratados con colgajos sensitivos se incorporaba más rápidamente a sus labores, con mejor percepción de la sensibilidad y con valores de presión de apoyo similares a las registradas en el pie sano no reconstruido (9). Se ha encontrado una mayor tasa de ulceración con el uso de colgajos musculares libres cubiertos con injertos de piel, siendo preferibles los colgajos fasciocutáneos.…”

Anatomic study of the deep plantar arch

“…The heel and plantar areas of the foot have specific biomechanical characteristics and play a distinct role in balance and standing (Kuran et al, 2000). Foot injuries caused by traffic and industrial accidents or burns are common, as are diabetic and vascular problems (Friedman et al, 1990;Hamada et al, 1994).…”

“…Such reconstruction often avoids amputation in cases of arterial trauma resulting from industrial and automobile accidents, as well as in patients with diabetes and severe ischemia of the lower limbs (Friedman et al, 1990;Gloviczki et al, 1994;Hamada et al, 1994;Luther and Lepantalo, 1997). Various flaps have been used for successful reconstruction of extensive plantar defects (Masquelet et al, 1988;Lin et al, 1991;Kuran et al, 2000). Using pedal artery bypass grafting in association with adequate local debridement, meticulous wound care, and reconstructive procedures when indicated, healing and limb salvage rates for heel lesions can approximate those seen with forefoot lesions (Berceli et al, 1999).…”