Muscle versus Fasciocutaneous Free Flaps in Heel Reconstruction: Systematic Review and Meta-Analysis

Fox, Carly M; Beem, Henry; Wiper, Jonathan D.; Rozen, Warren M.; Wagels, Michael; Leong, James

doi:10.1055/s-0034-1384674

Cited by 54 publications

(70 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…But as previous reports show that there is no significant difference in flap survival in regard to the flap type. 25 Nevertheless, further study may be warranted to see the outcome for reconstruction on ischemic regions.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction Using Free Flaps for Diabetic Heel Defects: Outcomes and Risk Factor Analysis

Kim

Altiparmak

Pak

et al. 2020

J Reconstr Microsurg

View full text Add to dashboard Cite

Background Overall success rate after diabetic foot reconstruction using free flap has been acceptable, but certain parts of the foot like the heel remains more challenging. Patients and Methods This retrospective study reviewed 37 patients reconstructed with free flaps for diabetic foot ulcer on the heel region from 2008 to 2017. Flap outcome in addition to various risk factors were analyzed; arterial status on heel, the American Society of Anesthesiologists (ASA) physical status, smoking, hypertension, hypercholesterolemia, chronic renal failure patient, hemoglobin A1c level, C-reactive protein, and osteomyelitis. Results Overall flap survival was 73% and resulted in limb salvage and functional ambulation. Total flap loss was 27% and the majority ended up with high-level amputation. Among the risk factors evaluated, the arterial status of the heel and ASA status significantly increased the odds for failure. When both arterial branches to the heel were impaired, the odds of failure were 80 times higher to fail (p< 0.05). Conclusion The vascularity of the surrounding tissue of the defect plays a critical role in overall success of diabetic heel reconstruction. Aggressive debridement using the angiosome concept is necessary to assure surrounding tissue has a good circulation. Despite the high chance of failure, success will lead to limb salvage and to reasonable functional ambulation whereas failure to salvage the heel will lead to higher level amputation. This warrants microsurgeons to make an effort to perform reconstruction to the heel defect after obtaining maximal vascularity after angioplasty.

show abstract

Section: Discussionmentioning

confidence: 99%

Reconstruction Using Free Flaps for Diabetic Heel Defects: Outcomes and Risk Factor Analysis

Kim

Altiparmak

Pak

et al. 2020

J Reconstr Microsurg

View full text Add to dashboard Cite

show abstract

“…However, the skingrafted surface of muscle flap remains inferior in the weightbearing areas and prone for recurrent ulceration requiring secondary procedures and specialized footwear. 12,13 Fasciocutaneous flap with minimal fascia around its pedicle essentially contains adequate fat and skin paddle that provide good cushioning effect akin to the native fat pad and superior surface for walking than split-thickness skin graft. The fascia, if preserved, not only provides poor vascular structure on the floor of ulcer but also results in feeling of walking on a slippery surface.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical Reconstruction of Plantar Ulcers of the Insensate Foot

Kadam

2016

J reconstr Microsurg

View full text Add to dashboard Cite

Background Plantar, neuropathic, or trophic ulcers are often found in patients with decreased sensation in the foot. These ulcers can be complicated by infection, deformity, and increased patient morbidity. Excision results in wider defects and local tissues are often insufficient for reconstruction Methods Total 26 free flaps were used in 25 patients to reconstruct plantar ulcers between years 2007 and 2013. The etiology included diabetic neuropathy (n = 13), leprosy (n = 3), spinal/peripheral nerve injury (n = 7), spina bifida (n = 1), and peripheral neuropathy (n = 1). The duration of the ulcer ranged from 1 to 18 years. Fifteen patients had associated systemic comorbidities and six had previous attempts. Free flaps used in reconstruction were the anterolateral thigh flap (n = 18), radial artery forearm flap (n = 4), and the gracilis muscle flap (n = 4). Recipient vessels were the posterior tibial artery (end to side) in 19 and the dorsalis pedis artery in 7. Results The average age at presentation was 44.6 years with mean duration of ulcer of 5.8 years predominantly located over weight-bearing areas. Mean size of ulcer was 59.45 cm(2) and mean follow-up period was 48 months. All flaps survived except a partial loss. Average time to resume ambulation was 6 weeks. Three patients had recurrence with mean follow-up of 48 months. Secondary flap reduction and bony resection was done in four. Conclusion Microvascular reconstruction of the sole has advantages of vascularity, adequate tissue, and leaving rest of the foot undisturbed for offloading. Three significant local conditions influencing selection and transfer of the flap include (1) distally located forefoot ulcers, (2) extensive subcutaneous fibrosis secondary to frequent inflammation, and (3) Charcot arthropathy. In our series, the anterolateral thigh flap is our first choice for reconstruction of these defects.

show abstract

“…Other options for soft-tissue reconstruction of the heel include the free latissimus dorsi and the radial artery forearm flaps. 34,35 Peek et al 5 reported one complete flap loss of two patients who underwent heel reconstruction with the free iliac crest transfer. Nevertheless, both patients regained adequate mobility.…”

Section: Discussionmentioning

confidence: 99%

Role of Free Iliac Crest Flap in Foot and Ankle Reconstruction

Repo

Barner-Rasmussen

Roine

et al. 2016

J reconstr Microsurg

View full text Add to dashboard Cite

Background Reconstruction of extensive bone and compound defects in the foot and ankle is challenging. This cross-sectional study aimed to assess the outcomes of free iliac crest flap in foot and ankle reconstruction. Methods We retrospectively reviewed patient records and identified 13 cases with 1 osseous and 12 composite free iliac crest grafts for compound fracture (n = 3) or sequelae (n = 10) in the foot and ankle. We applied the visual analogue scale foot and ankle, the Oswestry disability index, and the 15D health-related quality of life (HRQoL) instruments. Results The average follow-up period was 3.9 years (range, 1.3-8.0 years). Four patients underwent early reoperations; venous and arterial reanastomosis (n = 1), minor wound revision (n = 2), or flap reconstruction due to partial necrosis of the skin island (n = 1). The median time to bone union was 23 months (range, 7-46 months). One permanent pseudoarthrosis occurred. One patient underwent late below-knee amputation due to chronic pain and functional impairment. One patient required flap reconstruction due to a late donor-site defect. Seven patients completed the questionnaires on an average of 14.7 years postoperatively (range, 2.0-26.9 years). Noted impairment of the donor site and of the reconstructed limb ranged from none to significant. Five (out of seven) patients had a HRQoL comparable to that of an age-standardized general population. Conclusions The free iliac crest flap is a feasible option for extensive compound fractures and bone-healing complications in the foot and ankle. It can also be used to achieve ankle arthrodesis when other techniques have failed and in patients at high risk for amputation.

show abstract

Muscle versus Fasciocutaneous Free Flaps in Heel Reconstruction: Systematic Review and Meta-Analysis

Cited by 54 publications

References 18 publications

Reconstruction Using Free Flaps for Diabetic Heel Defects: Outcomes and Risk Factor Analysis

Reconstruction Using Free Flaps for Diabetic Heel Defects: Outcomes and Risk Factor Analysis

Microsurgical Reconstruction of Plantar Ulcers of the Insensate Foot

Role of Free Iliac Crest Flap in Foot and Ankle Reconstruction

Contact Info

Product

Resources

About