Longitudinal Outcomes and Application of the Subunit Principle to 165 Foot and Ankle Free Tissue Transfers

Abstract

The use of free tissue transplantation for treatment of foot and ankle wounds is associated with a high rate of limb salvage. Although a variety of flaps may be used, the application of the subunit principle can assist surgeons in designing flaps that will address subunit-specific functional and aesthetic concerns.

An Algorithmic Approach for Managing Orthopaedic Surgical Wounds of the Foot and Ankle

“…Although it is the most complex, free tissue transfer may not be necessary in all circumstances. Our algorithm and prior publications indicate that it is often the most suitable first option in accordance with our subunit approach and established orthoplastic principles [17,19]. However, for superficial wounds that do not extend to the level of tendon or joint, use of a xenograft matrix may be an effective alternative with less morbidity (Fig.…”

“…The orthoplastic approach, which integrates the expertise and surgical techniques of the two specialties, also may permit improvements in the management of foot and ankle problems that are not related to trauma. We previously described our subunit approach for soft tissue coverage of foot and ankle wounds with free tissue transfer in 161 patients [17]. This approach allows the selection of flap tissue to be tailored to the functional demands of a specific anatomic region of the foot and ankle.…”

“…We have described our experience with free tissue transfer for soft tissue coverage of the foot and ankle in 161 patients [17]. The majority of these patients (75%) required free tissue transfer to treat sequelae of trauma.…”

The Lateral Plantar Artery as Recipient Vessel for Microsurgical Lateral Plantar Forefoot Reconstruction: Case Report

“…The ideal coverage to plantar forefoot is to use durable soft tissue with minimal bulkiness and follow the principle of "replace like tissue with like" [1]. Therefore, glabrous plantar skin from the spare part of foot is the first choice.…”

“…With the advent of microsurgical techniques, free flaps become more and more popularly employed in plantar forefoot reconstruction [1][2][3][4][5][6][7]. Although the choice of an optimal flap is very important, the selection of appropriate recipient vessels is also equally crucial.…”