Foot Reconstruction Workup

  • Author: Fabio Santanelli, MD, PhD; Chief Editor: Jorge I de la Torre, MD, FACS   more...
 
Updated: Dec 12, 2011
 

Laboratory Studies

  • Obtain a complete blood count (CBC).
  • Obtain prothrombin time and activated partial thromboplastin time to check for coagulopathy.
  • Check for blood sugar if suggested by anamnesis.
Next

Imaging Studies

  • Obtain leg and/or foot radiographs for patients with trauma or for osteocutaneous free transfers.Radiograph illustrating the dispositions of the shRadiograph illustrating the dispositions of the shafts in the ankle joint and the heel.
  • Obtain a chest radiograph if indicated by examination findings or the patient's history.
  • Obtain leucocyte lymphoscintigraphy in patients with osteomyelitis.
  • Obtain baropodometric evaluation or gait analysis to identify eventual bone functional loss and to plan a repair of the arches.Computerized baropodometry of the foot. Views of tComputerized baropodometry of the foot. Views of the different pressure levels.
  • Nuclear magnetic resonance especially is indicated to study ligaments and joints but also to evaluate the soft tissue damage.Nuclear magnetic resonance of the foot. This examiNuclear magnetic resonance of the foot. This examination best shows bone, joints, and ligaments as well as the soft tissues. Nuclear magnetic resonance is important when making the diagnosis in ankle or heel diseases.
Previous
Next

Other Tests

  • Perform Doppler, echo Doppler, or angiography to assess the vascular pattern of the foot and leg.
  • Perform an Allen test in patients with radial free flaps.
  • Obtain an ECG in elderly individuals or as per operating room guidelines.
Previous
Proceed to Treatment & Management
 
 
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, International Confederation for Plastic and Reconstructive Surgery, Osservatorio Nazionale Identità di Genere, Società Italiana di Microchirurgia, and Swedish Associations of Plastic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Francesca Romana Grippaudo  MD, Assistant Professor, Department of Plastic Surgery, Faculty of Medicine and Psycology, Sapienza University of Rome, Italy

Francesca Romana Grippaudo is a member of the following medical societies: International Confederation for Plastic and Reconstructive Surgery and Italian Society of Plastic Reconstructive Surgery and Aesthetics

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

Emanuele Cigna, MD is a member of the following medical societies: Italian Society of Plastic Reconstructive Surgery and Aesthetics and World Society for Reconstructive Microsurgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Christian Paletta  MD, Complex Wound and Limb Salvage Program, Walter Reed Army Hospital and Bethesda Naval Hospital

Christian Paletta 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, 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, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; 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.

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. Sarzaeem MM, Lemraski MM, Safdari F. Chronic Achilles tendon rupture reconstruction using a free semitendinosus tendon graft transfer. Knee Surg Sports Traumatol Arthrosc. Oct 29 2011;[Medline].

  15. Ahmed SK, Fung BK, Ip WY, Chow SP. Lateral tibial condyle reconstruction by pedicled vascularized fibular head graft: long-term result. Strategies Trauma Limb Reconstr. May 17 2011;[Medline].

  16. Gomez MM, Casal D. Reconstruction of Large Defect of Foot with Extensive Bone Loss Exclusively Using a Latissimus Dorsi Muscle Free Flap: A Potential New Indication for This Flap. J Foot Ankle Surg. Sep 23 2011;[Medline].

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

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

  19. 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].

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

  21. 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].

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

  23. 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].

  24. 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].

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

  26. 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].

  27. 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].

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

 
Previous
Next
 
Different evolutions of the foot in primates.
View of the 2 arches of the foot.
Lateral and medial views of the vectors.
Xeroradiography shows the dispositions of the shafts and the 2 arches theory.
Radiograph illustrating the dispositions of the shafts in the ankle joint and the heel.
Computerized baropodometry of the foot. Views of the different pressure levels.
Nuclear magnetic resonance of the foot. This examination best shows bone, joints, and ligaments as well as the soft tissues. Nuclear magnetic resonance is important when making the diagnosis in ankle or heel diseases.
Medial plantar flap, instep flap (O'Brien and Shanahan, 1979).
Dorsalis pedis flap, described by McCraw and Furlow (1975).
Medialis pedis flap described by Masquelet (1990).
Lateral calcaneal artery skin flap, described by Grabb and Argenta (1981).
Sural flap; perforator flap from peroneal artery; described by Donski and Fogdestam, 1983.
Perforator flap from the peroneal artery.
Soleus muscle flap.
Dystrophic ulcer of the heel.
First web space flap based on pedidial artery.
Flap from the first web space (4 X 6 cm).
The flap is transferred to reconstruct the posterior heel defect; reconstruction of the donor area by split-thickness skin graft.
Long-term view of the donor area.
Crush injury of the forefoot, plantar view.
Crush injury of the forefoot, dorsal view.
Injury of the foot after debridement and reconstruction by means of free latissimus dorsi muscle transfer with mesh skin graft, revascularized end to end on the posterior tibial artery and vein.
Long-term result, plantar view, after repair of injury of the foot.
Long-term result, dorsal view, after repair of injury of the foot.
Avulsion of the foot sole, plantar view.
Avulsion of the foot sole, side view.
Planning of a large forearm flap.
Long-term result after reconstruction with free forearm transfer revascularized side to end on the posterior tibial artery and vein.
Side view after reconstruction of the sole with free forearm flap transfer, long-term result.
Table 3. Surgical Options for Foot Reconstruction
DimensionExtensionLocalizationType of Flap
< 3 cm 2Soft tissueWeightbearing areasLocal flap
< 3 cm 2Soft tissueNonweightbearing areasSkin grafts
>3 cm 2Soft tissueWeightbearing areasFree flap (free fasciocutaneous, musculocutaneous flaps, muscle free flap plus skin graft)
>3 cm 2Soft tissue and bone lossWeightbearing areasFree osteocutaneous flap
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
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.