eMedicine Specialties > Plastic Surgery > Lower Extremity Reconstruction

Lower Extremity Reconstruction, Foot: Follow-up

Author: Fabio Santanelli, MD, PhD, Associate Professor of Plastic Surgery, University of Rome; Chief of Unita Operativa Dipartimentale di Chirurgia Plastica, Azienda Ospedaliera, Sant'Andrea, Rome
Coauthor(s): Francesca Romana Grippaudo, MD, Assistant Professor, Unit of Plastic Surgery, 2nd Medical Faculty, Sapienza University of Rome, Italy; Stefania Tenna, MD, Consulting Staff, Department of Plastic Surgery, University of Rome Policlinico Umberto I, Italy; Guido Paolini, MD, Plastic Surgery Unit, Assistant Professor of Plastic Surgery, Sant'Andrea Hospital- University of Rome La Sapienza -Italy; Emanuele Cigna, MD, Consultant Plastic Surgeon, Department of Plastic and Reconstructive Surgery, University of Rome La Sapienza, Italy
Contributor Information and Disclosures

Updated: Jun 26, 2008

Outcome and Prognosis

  • The treatment of foot ulcers is often difficult, with a relatively high incidence of recurrence, especially in older patients with vascular or dysmetabolic diseases.
  • Always consider the general condition of the patient in advance to plan the most correct treatment of the local defect. The prognosis is strictly dependent on the age of the patient and the etiology of the defect.
  • From a surgical point of view, flaps usually give a better result than grafts, with a low rate of breakdowns or recurrence. However, grafts can be remarkably durable on weightbearing (WB) areas and may be the first choice in certain situations.
  • Even if grafts are advisable in some patients, local flaps provide the most similar tissue and must be the first choice when the defect is not less than 3 cm wide.
  • The advent of microsurgery and the use of free flaps have changed the approach for the treatment of large defects.
  • Fasciocutaneous flaps for pure soft tissue loss are versatile and usually offer a suitable paddle of tissue to reconstruct either WB or nonweightbearing (NWB) areas. Surgical recovery is fast, and the patient can wear normal shoes early on.
  • Muscular or myocutaneous flaps must be necessary in large avulsions with bone infection. Surgical recovery with these flaps can be slightly longer, especially because of their thickness, which prohibits the use of normal shoes.
  • Myocutaneous flaps, particularly bulky in the beginning, usually reduce their thickness in 6 months because of the process of atrophy of the denervated muscle.
  • Finally, osteocutaneous flaps truly represent the option to avoid amputation, restoring not only the loss of tissue but especially the function of the foot in the gait.
  • The future of this field will be influenced by new technologies and cellular cultures, with the possibility of reproducing any type of tissue in the laboratory.
 


More on Lower Extremity Reconstruction, Foot

Overview: Lower Extremity Reconstruction, Foot
Workup: Lower Extremity Reconstruction, Foot
Treatment: Lower Extremity Reconstruction, Foot
Follow-up: Lower Extremity Reconstruction, Foot
Multimedia: Lower Extremity Reconstruction, Foot
References
[ CLOSE WINDOW ]

References

  1. McCraw JB. Selection of alternative local flaps in the leg and foot. Clin Plast Surg. Apr 1979;6(2):227-46. [Medline].

  2. Shanahan RE, Gingrass RP. Medial plantar sensory flap for coverage of heel defects. Plast Reconstr Surg. Sep 1979;64(3):295-8. [Medline].

  3. Grabb WC, Argenta LC. The lateral calcaneal artery skin flap (the lateral calcaneal artery, lesser saphenous vein, and sural nerve skin flap). Plast Reconstr Surg. Nov 1981;68(5):723-30. [Medline].

  4. McCraw JB, Furlow LT Jr. The dorsalis pedis arterialized flap. A clinical study. Plast Reconstr Surg. Feb 1975;55(2):177-85. [Medline].

  5. Masquelet AC, Romana MC. The medialis pedis flap: a new fasciocutaneous flap. Plast Reconstr Surg. May 1990;85(5):765-72. [Medline].

  6. Baudet J, Guimberteau JC, Nascimento E. Successful clinical transfer of two free thoraco-dorsal axillary flaps. Plast Reconstr Surg. Dec 1976;58(6):680-8. [Medline].

  7. Robinson DW. Microsurgical transfer of the dorsalis pedis neurovascular island flap. Br J Plast Surg. Jul 1976;29(3):209-13. [Medline].

  8. Dos Santos F. L'artere scapulaire posterieure. Paris; 1980.

  9. Acland RD, Schusterman M, Godina M, et al. The saphenous neurovascular free flap. Plast Reconstr Surg. Jun 1981;67(6):763-74. [Medline].

  10. Song R, Song Y, Yu Y. The upper arm free flap. Symposium on one stage reconstruction. In: Song R, ed. Clinics in Plastic Surgery. Vol 9. New York: WB Saunders; 1982:27-36.

  11. Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg. May 1975;55(5):533-44. [Medline].

  12. Taylor GI. The current status of free vascularized bone grafts. Clin Plast Surg. Jan 1983;10(1):185-209. [Medline].

  13. Hidalgo DA, Shaw WW. Reconstruction of foot injuries. Clin Plast Surg. Oct 1986;13(4):663-80. [Medline].

  14. Donski PK, Fogdestam I. Distally based fasciocutaneous flap from the sural region: a preliminary report. Scand J Plast Surg. 1983;17:191.

  15. Pakiam AI. The reversed dermis flap. Br J Plast Surg. Apr 1978;31(2):131-5. [Medline].

  16. Nassif TM, Vidal L, Bovet JL, et al. The parascapular flap: a new cutaneous microsurgical free flap. Plast Reconstr Surg. Apr 1982;69(4):591-600. [Medline].

  17. Chang Di Sheng. Radial artery fascial flap. Presented at: Annual Meeting of the American Society of Plastic Reconstructive Surgery. Honolulu, HI; October 1982.

  18. Masuoka T, Nomura S, Yoshimura K, et al. Deep inferior epigastric perforator flap for foot reconstruction using an external pedicle. J Reconstr Microsurg. May 2005;21(4):231-4. [Medline].

  19. Mathes SJ, Nahai F. Clinical application for muscle and musculocutaneous flaps. St Louis: Mosby; 1982.

  20. Morrison WA, Crabb DM, O'Brien BM, et al. The instep of the foot as a fasciocutaneous island and as a free flap for heel defects. Plast Reconstr Surg. Jul 1983;72(1):56-65. [Medline].

  21. Nerlich AG, Zink A, Szeimies U, et al. Ancient Egyptian prosthesis of the big toe. Lancet. Dec 23-30 2000;356(9248):2176-9. [Medline].

  22. O'Brien B McC, Morrison WA. Reconstructive Microsurgery. Churchill Livingstone; 1987.

  23. O'Brien BM, MacLeod AM, Hayhurst JW, et al. Successful transfer of a large island flap from the groin to the foot by microvascular anastomoses. Plast Reconstr Surg. Sep 1973;52(3):271-8. [Medline].

  24. Organek AJ, Klebuc MJ, Zuker RM. Indications and outcomes of free tissue transfer to the lower extremity in children: review. J Reconstr Microsurg. Apr 2006;22(3):173-81. [Medline].

  25. Strauch B, Vasconez LO, Hall-Finlay EJ. Grabb's Encyclopedia of Flaps. Vol 3. 2nd ed. Philadelphia: Lippincott-Raven; 1998.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

lower extremity reconstruction, foot surgery, foot pressure, foot reconstruction, foot surgery, weightbearing, foot defects, foot ulcers, padding properties, body weight, foot flap, saphenous nerve, sciatic nerve, ankle, sole, dorsum, toes, extensor brevis digitorum, extensor hallucis, metatarsal bones, anterior tibial pedicle, posterior tibial pedicle, peroneal pedicle, internal plantar nerve, posterior tibial nerve

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Fabio Santanelli, MD, PhD, Associate Professor of Plastic Surgery, University of Rome; Chief of Unita Operativa Dipartimentale di Chirurgia Plastica, Azienda Ospedaliera, Sant'Andrea, Rome
Fabio Santanelli, MD, PhD is a member of the following medical societies: American Society of Plastic and Reconstructive Surgery, European Association of Plastic Surgeons, and International Confederation for Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Francesca Romana Grippaudo, MD, Assistant Professor, Unit of Plastic Surgery, 2nd Medical Faculty, Sapienza University of Rome, Italy
Francesca Romana Grippaudo, MD is a member of the following medical societies: International Confederation for Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Stefania Tenna, MD, Consulting Staff, Department of Plastic Surgery, University of Rome Policlinico Umberto I, Italy
Disclosure: Nothing to disclose.

Guido Paolini, MD, Plastic Surgery Unit, Assistant Professor of Plastic Surgery, Sant'Andrea Hospital- University of Rome La Sapienza -Italy
Disclosure: Nothing to disclose.

Emanuele Cigna, MD, Consultant Plastic Surgeon, Department of Plastic and Reconstructive Surgery, University of Rome La Sapienza, Italy
Disclosure: Nothing to disclose.

Medical Editor

Christian Paletta, MD, FACS, Professor, Division Chief and Program Director, Department of Plastic and Reconstructive Surgery, St Louis University School of Medicine
Christian Paletta, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Plastic Surgeons, American Burn Association, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, and Missouri State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

B Sekhar Chandrasekhar, MD, Associate Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Southern California
B Sekhar Chandrasekhar, MD is a member of the following medical societies: American Association of Plastic Surgeons, American College of Surgeons, American Society for Reconstructive Microsurgery, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.