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Simultaneous Reconstruction of Forefoot and Hindfoot Defects with a Thoracodorsal-Axis Chimeric Flap.

Lee JH, Kang HW, Kim SM, Jun YJ, Kim YJ - Arch Plast Surg (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Bucheon, Korea.

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To achieve successful results in foot reconstruction, both form and function should be restored... The reconstruction of soft tissue should be durable against pressure and permit the patient to wear near-normal shoes... Here, we present a case with large soft-tissue defects in the patient's forefoot and hindfoot that were simultaneously reconstructed using a thoracodorsal-axis chimeric flap... Four weeks after the procedure, complete weight bearing on the reconstructed area was allowed... During the 10 months of follow-up, no major complications occurred, including flap necrosis or wound disruption, and the patient did not feel discomfort upon wearing shoes or walking... Of the pedicled flaps, a sural artery flap, which is frequently used for hindfoot defects, has high complication rates, particularly in patients with DM and arterial and venous insufficiency... The chimeric flap has several advantages... First, it can achieve the same effect as a combination of 2 or 3 free flaps by expanding the surface of the flap without additional donor-site morbidity when an extensive soft-tissue defect needs covering... We think that in this patient, the defect could be covered with one large fasciocutaneous flap after the removal of the plantar skin bridge between two defects... However, this method could destroy the normal plantar arch and result in a flatfoot deformity... Further, to preserve the plantar arch by using this method, the transition zone from hindfoot to forefoot should be narrowly designed; hence, the distal portion (forefoot) of the flap might have insufficient blood flow if the skin perforator is located in the proximal portion (hindfoot) of the flap... Lastly, the skin graft over the muscle flap is less durable than the fasciocutaneous flap and tends to form a callus... To prevent this complication, a perforator-based fasciocutaneous chimeric flap, which enables an independent inset of components, seems to be more ideal.

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(A, B) Result at postoperative 10 months. Both flaps completely survived and withstood the daily stress of walking. The normal foot contour was also preserved.
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Figure 3: (A, B) Result at postoperative 10 months. Both flaps completely survived and withstood the daily stress of walking. The normal foot contour was also preserved.

Mentions: Four weeks after the procedure, complete weight bearing on the reconstructed area was allowed. During the 10 months of follow-up, no major complications occurred, including flap necrosis or wound disruption, and the patient did not feel discomfort upon wearing shoes or walking. A callus tended to form in the heel area, but this was alleviated after wearing specialized diabetic footwear. The contour of the reconstructed foot was satisfactory (Fig. 3).


Simultaneous Reconstruction of Forefoot and Hindfoot Defects with a Thoracodorsal-Axis Chimeric Flap.

Lee JH, Kang HW, Kim SM, Jun YJ, Kim YJ - Arch Plast Surg (2015)

(A, B) Result at postoperative 10 months. Both flaps completely survived and withstood the daily stress of walking. The normal foot contour was also preserved.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660005&req=5

Figure 3: (A, B) Result at postoperative 10 months. Both flaps completely survived and withstood the daily stress of walking. The normal foot contour was also preserved.
Mentions: Four weeks after the procedure, complete weight bearing on the reconstructed area was allowed. During the 10 months of follow-up, no major complications occurred, including flap necrosis or wound disruption, and the patient did not feel discomfort upon wearing shoes or walking. A callus tended to form in the heel area, but this was alleviated after wearing specialized diabetic footwear. The contour of the reconstructed foot was satisfactory (Fig. 3).

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Bucheon, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

To achieve successful results in foot reconstruction, both form and function should be restored... The reconstruction of soft tissue should be durable against pressure and permit the patient to wear near-normal shoes... Here, we present a case with large soft-tissue defects in the patient's forefoot and hindfoot that were simultaneously reconstructed using a thoracodorsal-axis chimeric flap... Four weeks after the procedure, complete weight bearing on the reconstructed area was allowed... During the 10 months of follow-up, no major complications occurred, including flap necrosis or wound disruption, and the patient did not feel discomfort upon wearing shoes or walking... Of the pedicled flaps, a sural artery flap, which is frequently used for hindfoot defects, has high complication rates, particularly in patients with DM and arterial and venous insufficiency... The chimeric flap has several advantages... First, it can achieve the same effect as a combination of 2 or 3 free flaps by expanding the surface of the flap without additional donor-site morbidity when an extensive soft-tissue defect needs covering... We think that in this patient, the defect could be covered with one large fasciocutaneous flap after the removal of the plantar skin bridge between two defects... However, this method could destroy the normal plantar arch and result in a flatfoot deformity... Further, to preserve the plantar arch by using this method, the transition zone from hindfoot to forefoot should be narrowly designed; hence, the distal portion (forefoot) of the flap might have insufficient blood flow if the skin perforator is located in the proximal portion (hindfoot) of the flap... Lastly, the skin graft over the muscle flap is less durable than the fasciocutaneous flap and tends to form a callus... To prevent this complication, a perforator-based fasciocutaneous chimeric flap, which enables an independent inset of components, seems to be more ideal.

No MeSH data available.


Related in: MedlinePlus