Laboratory Studies

See the list below:

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.

Imaging Studies

See the list below:

Obtain leg and/or foot radiographs for patients with trauma or for osteocutaneous free transfers.

Radiograph illustrating the dispositions of the shafts in the ankle joint and the heel.
View Media Gallery
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 the different pressure levels.
View Media Gallery
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 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.
View Media Gallery

Other Tests

Perform Doppler, echo Doppler, or angiography to assess the vascular pattern of the foot and leg and identify perforators as a possible source of pedicled, propeller, or free flaps.

Perform an Allen test in patients with radial free flaps.

Obtain an ECG in elderly individuals or as per operating room guidelines.

Treatment & Management

Ring A, Kirchhoff P, Goertz O, et al. Reconstruction of Soft-Tissue Defects at the Foot and Ankle after Oncological Resection. Front Surg. 2016. 3:15. [Medline]. [Full Text].
McCraw JB. Selection of alternative local flaps in the leg and foot. Clin Plast Surg. 1979 Apr. 6(2):227-46. [Medline].
Shanahan RE, Gingrass RP. Medial plantar sensory flap for coverage of heel defects. Plast Reconstr Surg. 1979 Sep. 64(3):295-8. [Medline].
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. 1981 Nov. 68(5):723-30. [Medline].
McCraw JB, Furlow LT Jr. The dorsalis pedis arterialized flap. A clinical study. Plast Reconstr Surg. 1975 Feb. 55(2):177-85. [Medline].
Masquelet AC, Romana MC. The medialis pedis flap: a new fasciocutaneous flap. Plast Reconstr Surg. 1990 May. 85(5):765-72. [Medline].
Baudet J, Guimberteau JC, Nascimento E. Successful clinical transfer of two free thoraco-dorsal axillary flaps. Plast Reconstr Surg. 1976 Dec. 58(6):680-8. [Medline].
Robinson DW. Microsurgical transfer of the dorsalis pedis neurovascular island flap. Br J Plast Surg. 1976 Jul. 29(3):209-13. [Medline].
Dos Santos F. L’artere scapulaire posterieure. Paris; 1980.
Acland RD, Schusterman M, Godina M, et al. The saphenous neurovascular free flap. Plast Reconstr Surg. 1981 Jun. 67(6):763-74. [Medline].
Song R, Song Y, Yu Y. The upper arm free flap. Symposium on one stage reconstruction. Song R, ed. Clinics in Plastic Surgery. New York: WB Saunders; 1982. Vol 9: 27-36.
Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg. 1984 Apr. 37 (2):149-59. [Medline].
Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002 Jun. 109 (7):2219-26; discussion 2227-30. [Medline].
Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987 Mar. 40 (2):113-41. [Medline].
Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg. 1989 Nov. 42 (6):645-8. [Medline].
Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg. 1994 Jan. 32 (1):32-8. [Medline].
Taylor GI, Doyle M, McCarten G. The Doppler probe for planning flaps: anatomical study and clinical applications. Br J Plast Surg. 1990 Jan. 43 (1):1-16. [Medline].
Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg. 1991 Jan. 44 (1):53-4. [Medline].
Teo TC. Perforator local flaps in lower limb reconstruction. Cir Plas Ibero-Latinoam. 2006. 32 (4):287. [Full Text].
Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg. 1995 Dec. 96 (7):1608-14. [Medline].
Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg. 2004 Sep 15. 114 (4):910-6. [Medline].
Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg. 1975 May. 55(5):533-44. [Medline].
Taylor GI. The current status of free vascularized bone grafts. Clin Plast Surg. 1983 Jan. 10(1):185-209. [Medline].
Hidalgo DA, Shaw WW. Reconstruction of foot injuries. Clin Plast Surg. 1986 Oct. 13(4):663-80. [Medline].
Sarzaeem MM, Lemraski MM, Safdari F. Chronic Achilles tendon rupture reconstruction using a free semitendinosus tendon graft transfer. Knee Surg Sports Traumatol Arthrosc. 2011 Oct 29. [Medline].
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. 2011 May 17. [Medline].
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. 2011 Sep 23. [Medline].
Struckmann V, Hirche C, Struckmann F, et al. Free and pedicled flaps for reconstruction of the weightbearing sole of the foot: a comparative analysis of functional results. J Foot Ankle Surg. 2014 Nov-Dec. 53(6):727-34. [Medline].
Crowe CS, Cho DY, Kneib CJ, Morrison SD, Friedrich JB, Keys KA. Strategies for Reconstruction of the Plantar Surface of the Foot: A Systematic Review of the Literature. Plast Reconstr Surg. 2019 Apr. 143 (4):1223-44. [Medline].
Donski PK, Fogdestam I. Distally based fasciocutaneous flap from the sural region: a preliminary report. Scand J Plast Surg. 1983. 17:191.
Pakiam AI. The reversed dermis flap. Br J Plast Surg. 1978 Apr. 31(2):131-5. [Medline].
Jeon BJ, Lee KT, Lim SY, et al. Plantar reconstruction with free thoracodorsal artery perforator flaps. J Plast Reconstr Aesthet Surg. 2013 Mar. 66(3):406-13. [Medline].
Hong JP, Kim EK. Sole reconstruction using anterolateral thigh perforator free flaps. Plast Reconstr Surg. 2007 Jan. 119(1):186-93. [Medline].
Yang X, Zhang G, Liu Y, Yang J, Ding M, Tang M. Vascular anatomy and clinical application of anterolateral leg perforator flaps. Plast Reconstr Surg. 2013 Apr. 131(4):534e-43e. [Medline].
Nassif TM, Vidal L, Bovet JL, et al. The parascapular flap: a new cutaneous microsurgical free flap. Plast Reconstr Surg. 1982 Apr. 69(4):591-600. [Medline].
Cho EH, Garcia RM, Pien I, et al. Vascular considerations in foot and ankle free tissue transfer: Analysis of 231 free flaps. Microsurgery. 2015 Mar 23. [Medline].
Heidekrueger PI, Ehrl D, Prantl L, et al. Microsurgical Reconstruction of the Plantar Foot: Long-Term Functional Outcomes and Quality of Life. J Reconstr Microsurg. 2019 Jun. 35 (5):379-88. [Medline].
Sato T, Yana Y, Ichioka S. Free flap reconstruction for diabetic foot limb salvage. J Plast Surg Hand Surg. 2017 Feb 13. 1-6. [Medline].

Media Gallery

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.

of 29

Author

Fabio Santanelli di Pompeo, MD, PhD Associate Professor of Plastic Surgery, Sapienza University of Rome School of Medicine and Psychology; Chief of Plastic Surgery Unit, Sant'Andrea Hospital, Rome

Fabio Santanelli di Pompeo, MD, PhD is a member of the following medical societies: American Society of Plastic Surgeons, International Confederation for Plastic, Reconstructive and Aesthetic Surgery, European Association of Plastic Surgeons, Societa Italiana di Microchirurgia, Swedish Associations of Plastic Surgeons, Osservatorio Nazionale Identit? di Genere

Disclosure: Nothing to disclose.

Coauthor(s)

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

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

Disclosure: Nothing to disclose.

Stefania Tenna, MD

Disclosure: Nothing to disclose.

Guido Paolini, MD, PhD Assistant Professor of Plastic Surgery, Department of Neuroscience, Mental Health and Sense Organs, Universita de Roma la Sapienza; Staff Plastic Surgeon, Sant’Andrea Hospital, Italy

Guido Paolini, MD, PhD is a member of the following medical societies: European Association of Plastic Surgeons, European Society of Plastic Reconstructive and Aesthetic Surgery, International Confederation for Plastic, Reconstructive and Aesthetic Surgery, Italian Society of Microsurgery, Italian Society of Plastic Reconstructive Surgery and Aesthetics, National Polispecialistic Society of Young Surgeons

Disclosure: Nothing to disclose.

Emanuele Cigna, MD, PhD Consultant Plastic Surgeon, Department of Surgery, Unit of Plastic Reconstructive and Hand Surgery, University of Rome La Sapienza, Italy

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, Association for Academic Surgery, Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Additional Contributors

Christian E Paletta, MD, FACS Clinical Professor of Surgery and Instructor of Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth; Clinical Professor of Surgery and Instructor in Surgery, Rwanda Human Resources for Health, Rwanda Ministry of Health and Clinton Health Access Initiative

Christian E Paletta, MD, FACS is a member of the following medical societies: American Society of Plastic Surgeons, Plastic Surgery Research Council, American Council of Academic Plastic Surgeons, American College of Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

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.

Dimension	Extension	Localization	Type of Flap
< 3 cm²	Soft tissue	Weightbearing areas	Local flap
< 3 cm²	Soft tissue	Nonweightbearing areas	Skin grafts
>3 cm²	Soft tissue	Weightbearing areas	Pedicled perforator or propeller flap, and/or free flap (free fasciocutaneous, musculocutaneous flaps, muscle free flap plus skin graft)
>3 cm²	Soft tissue and bone loss	Weightbearing areas	Free osteocutaneous flap

Foot Reconstruction Workup

Laboratory Studies

Imaging Studies

Other Tests

References

Tables

Contributor Information and Disclosures

What would you like to print?