Free tensor fascia lata true‐perforator flap transfer for reconstruction of the calcaneal soft tissue defect complicated with osteomyelitis in a patient with alcohol‐induced Charcot foot: A case report and literature review

Abstract

Charcot foot is can result in bone deformities and soft tissue defects. We report a case of alcohol‐induced Charcot (AIC) foot with soft tissue defect including the weight‐bearing zone of the heel and osteomyelitis, which was successfully reconstructed with free tensor fascia lata true‐perforator flap (TFLtp). A 56‐year‐old male suffered from AIC foot with an 18 × 6 cm defect. Based on the preoperative ultrasound, we identified the overlying upper thigh area offering one of the thickest dermis. A TFLtp flap was raised sparing the TFL muscle based on one perforator without including the main trunk of the transverse/ascending branch of the lateral femoral circumflex vessel. The TFLtp flap was transferred to the heel and anastomosed to the posterior tibial artery in an end‐to‐side fashion. The patient complained no postoperative discomfort of the donor site and was able to walk on his foot after 5 weeks. This case report highlights that the TFLtp flap may offer thick dermis, faster surgery due to perforator level dissection and a concealed donor site.

Microvascular Muscle vs. Fascio-Cutaneous Free Flaps for Reconstruction of Plantar Load-Bearing Foot Defects—An International Survey

“…Due to the size of the latissimus dorsi, it can provide total plantar coverage [ 8 ]. Other muscle free flaps used for reconstruction of plantar load-bearing foot defects include serratus [ 28 ], rectus abdominis [ 29 ], tensor fascia latae [ 30 , 31 ], and biceps femoris [ 32 ], among others. They offer advantages such as a constant vascular supply, low anatomical variability, overall low donor morbidity, and ease of harvesting [ 33 , 34 ].…”

Foot and ankle reconstruction using the lateral supramalleolar flap versus the anterolateral thigh flap in the elderly: A comparative study

“…Its reconstruction poses unique challenges due to its requirements for durable soft tissue that can withstand the load-bearing function of the plantar surface while providing a thin, pliable contour for resurfacing the dorsal foot and ankle. 1,2 With the rapid development of microsurgical techniques and reliable flap survival in flap transfers, the use of free flap such as the anterolateral thigh (ALT) flap has been gaining more popularity in the reconstruction of such patients. 3,4 However, free flaps represent the highest rung on the reconstructive ladder, requiring technically demanding, costly, and timeconsuming operations, with significant complication rates, donor-site morbidity, failure rates, and risk at the anastomosis.…”

“…In recent years, with the significantly increased number of car and motorcycle accidents, tissue losses from the foot and ankle region are becoming increasingly frequent. Its reconstruction poses unique challenges due to its requirements for durable soft tissue that can withstand the load‐bearing function of the plantar surface while providing a thin, pliable contour for resurfacing the dorsal foot and ankle 1,2 . With the rapid development of microsurgical techniques and reliable flap survival in flap transfers, the use of free flap such as the anterolateral thigh (ALT) flap has been gaining more popularity in the reconstruction of such patients 3,4 .…”