Free Flap Reconstruction of the Sole of the Foot with or without Sensory Nerve Coaptation

Abstract

The authors present a retrospective study on major plantar foot reconstruction to evaluate the role of the free fasciocutaneous flap and the importance of sensory nerve reconstruction in improving long-term results. Between 1995 and 1999, 20 patients with major defects of the sole of the foot underwent free forearm flap reconstruction performed by the senior author (F.S.). Sensory nerve reconstruction was added to this technique in 1997. The age and sex of the patients and the cause, location, and dimensions of their defects were recorded. The patients were clinically and neurophysiologically evaluated at 3, 6, and 12 months after the procedure for the following parameters: flap contour, flap stability, load capacity, walking ability, touch sensation, pain sensation, static two-point discrimination, and thermal sensibility. Dermatomic somatosensory-evoked potentials were also tested at 12 months. Follow-up ranged from 1 to 5 years. Patients were divided into two groups according to sensory nerve reconstruction. Group A consisted of 11 patients with nerve repair, and group B consisted of nine patients without nerve repair. One patient from group A who had an idiopathic neuropathy was excluded from the study because of interference with the reinnervation process. Five more patients (three from group A and two from group B) were lost at follow-up and excluded from the study. The final sample size in each group was seven. Data from both groups were compared and statistically analyzed with the Mann-Whitney test and the Fisher exact test. Long-term results confirmed in all reconstructions long-lasting stability. During the first postoperative year, patients with sensory nerve reconstruction showed better sensibility. The statistical analyses confirmed significant differences between the two groups to be dependent upon surgical technique at 3 and 6 months. Two-point discrimination and dermatomic somatosensory-evoked potentials were recorded. After 12 months, flaps without surgical nerve repair showed progressive improvement of sensitive thresholds, achieving a good protective sensibility, similar to that of the other group, but these flaps never regained two-point discrimination or dermatomic somatosensory-evoked potentials.

Distally based sural fasciomyocutaneous flap: Anatomic study and modified technique for complicated wounds of the lower third leg and weight bearing heel

“…However, this part of flap may be reinnervated through the peripheral neural ingrowth from the recipient wound, or from the sprouting of the repaired sural nerve. 31 The protective sensation was observed at the central area of the flap that received the nerve repair.…”

Reconstruction of Sole of Foot: A Retrospective Study of 26 Consecutive Cases

“…Similar findings were noted by authors of larger studies. 6 it is also notable that, the sensation in the plantar foot as a deciding factor for attempts at limb salvage are being questioned by well-performed studies and newer limb salvage indices 7. This is probably due to improvement in allied technologies like orthotics and podiatry.…”

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).…”

“…Los colgajos no sensitivos lograron a los 12 meses una mejor sensibilidad protectora, pero sin lograr recuperar discriminación a dos puntos o potenciales somatosensoriales evocados (10).…”