Reconstruction of foot defects with free lateral arm fasciocutaneous flaps: analysis of fifty patients

Abstract

In this article, long-term outcomes of foot reconstruction with free lateral arm fasciocutaneous flaps were retrospectively analyzed in 50 patients. The patients, 38 men and 12 women, ranged in age from 7-73 years (mean, 43.5 years). Indications for surgery included trauma (32 patients), diabetes mellitus (7 patients), burns (7 patients), chronic ulcers (3 patients), and tumor (1 patient). The locations of defects were the dorsum (n=21), ankle (n=12), medial (n=6), lateral (n=6), posterior heel (n=2), and distal sole (n=3) Concomitant bone injury occurred in 5 cases, and the weight-bearing surface of the foot was involved in 5 patients. Defects ranged in size from 27-76 cm(2) (mean, 36.4 cm(2)). Successful reconstructions were accomplished in 46 cases (92%). Flap complications included total flap loss and below-knee amputation (1 patient) and partial flap loss (3 patients); 75% (3/4) of these cases had diabetes as a comorbid factor, and 25% (1/4) had a concomitant bone injury. Six patients with dorsum defects required debulking of the flap (11.1%). None of the patients required modified shoes. In the majority of cases, flaps provided stable coverage and a gain in protective deep-pressure sensation. In long-term follow-up (up to 4 years), patients regained their ambulation, free of pain. Even in weight-bearing areas, none of the cases experienced ulceration or skin breakdown. Free lateral arm flaps provided excellent durability, with solid bony union and successful restoration of the contour of the foot in moderate-sized foot defects.