Foot and Ankle Reconstruction Using the Radial Forearm Flap: A Review of 25 Cases

Abstract

Twenty-five patients underwent soft-tissue reconstruction of the different anatomic regions of the foot and ankle using the microvascular radial forearm free flap. The patients, 19 men and 6 women, ranged in age from 3 to 80 years (mean, 48.4 years). Indications for the surgery included diabetes and/or vascular insufficiency (10 patients), trauma (9 patients), tumor (3 patients), gunshot wound (2 patients), and burn (1 patient). Osteomyelitis occurred in patients with traumatic (3 patients) and diabetic (3 patients) wounds. The weight-bearing surface of the foot was involved in eight patients. Defects ranged in size from 45 to 210 cm2 (mean, 100.4 cm2). The radial forearm flap was successful in 23 of 25 cases (92 percent). Flap complications included flap loss (two patients), infection (three patients), and minor wound dehiscence at the flap-leg skin interface (two patients). Recurrent ulceration occurred in two patients; both were diabetics with weight-bearing flaps. Donor site complications included partial skin graft loss with tendon exposure in two patients; both healed with conservative management. Recurrent or persistent osteomyelitis was not seen in any of the patients. Of the eight patients with weight-bearing flaps, four were ambulatory, one had limited ambulation, one was nonambulatory, one had too short a follow-up, and one suffered flap loss. Two patients required modified shoes. Debulking was performed in one patient. Follow-up ranged from 2 to 72 months (mean, 24.9 months). The radial forearm flap meets most of the anatomic prerequisites for the ideal foot flap. It facilitates the restoration of normal foot contour by replacing "like-with-like," allowing patients to use normal shoes without the need for debulking (except in one patient); it provides a durable and stable weight-bearing plantar surface during ambulation; it achieves excellent aesthetic results without the dryness or cracking of the hypertrophied skin-grafted muscle; and it permits sensory reinnervation. We have found it especially useful for resurfacing the dorsum, ankle, and forefoot, moderate-sized defects, weight-bearing surfaces, and osteomyelitic wounds.

Instep free flap for plantar soft tissue reconstruction: Indications and options

“…[24][25][26] However, fasciocutaneous flaps are advantageous in superficial defects without bony irregularities, because they are thin and pliable and provide better sensation. [27][28][29] Protective sensation is important for flap durability in weight-bearing areas, and has repeatedly been reported in muscle flaps and fasciocutaneous flaps alike. 28,[30][31][32] However, the debate about innervated flaps for reconstruction of plantar defects is controversial.…”

“…Although tactile sensation is clearly superior in fasciocutaneous flaps, this does not appear to be necessary to maintain an intact and functional plantar surface. 27,28,[30][31][32] Nevertheless, flaps transferred to insensate areas are more prone to damage because of the lack of deep pressure sensation and unfavorable weight distribution. 32 Patients with impaired sensation may therefore benefit from innervated flaps.…”

Lower extremity reconstruction

“…Microvascular fasciocutaneous flaps have become increasingly popular for reconstruction of the foot because they tend to be thin, limiting the bulkiness of the reconstruction [24]. Some examples of fasciocutaneous flaps that can provide stable and aesthetic coverage of the foot include a radial forearm flap, a scapula flap, an anterolateral thigh flap and a lateral arm flap.…”

“…Although Weinzweig and Davies http://gateway. ut.ovid.com/gw2/-60 [24] indicated that sensory reinnervation may be beneficial, they were not sure if the addition of sensation to the foot would protect against wound breakdown. Other studies have http://gateway.…”

Blood flow in free micro-vascular flaps

“…Lower extremity defects can also be reconstructed with free fasciocutaneous flaps (179,191). Such flaps consist of skin, subcutaneous tissue and fascia.…”