Soft Tissue Reconstruction of Foot and Ankle Defects: Free Vs Pedicled Flaps with the Use of 6 Different Flaps in 50 Cases of Road Traffic Accidents

Background: Soft tissue reconstruction of the foot and ankle still remains a complex and challenging process despite advances in the transfer of fasciocutaneous, musculocutaneous, and composite flaps. The development of microsurgery and the expansion of plastic surgery techniques have led to an increase in number of reconstructive options for the salvage of lower extremities and thereby causing dilemma regarding use of pedicled flaps for foot reconstruction. We present our comparative study with the use of pedicled as well as free flaps for soft tissue reconstruction of the foot and ankle. Materials and Methods: From 2008 to 2013, the soft tissue defects of traumatic injuries of the foot & ankle were reconstructed using 6 different flaps in 50 cases (32 male and 18 female). There were 22 pedicled flaps and 28 free flaps used in reconstruction. The pedicled flaps included reverse sural flap, pedicled peroneal artery perforator flap and pedicled tibial artery perforator flap. The free flaps were LD musculocutaneous flap, ALT musculocutaneous flap and Vastuslateralis muscle flap. The sensory nerve coaptation was performed in 8 patients only. Results: Among 28 free flaps, 3 flaps were completely lost as against 1 flap in pedicled flap group, in which the defects were managed by the secondary procedures. The donor site complications were seen in 1 case with the free flaps and 3 cases with pedicled flap. All limbs were preserved and the patients regained walking and daily activities. Out of 10 pedicled flaps and 8 free flaps used to reconstruct hind foot, ulcers developed in 2 pedicled flaps and 3 free flaps (muscle with STSG) after weight bearing. All the patients in whom nerve co-optation was done regained protective sensation from 6 to 12 months postoperatively. Conclusion: A careful pre & per-operative planning with special emphasis to be given on size and location of the defect and correct contour match and insetting should allow for maximal functional and aesthetic result with minimal post-operative morbidity. The loco-regional flaps are good options for the coverage of defects around ankle & dorsal hind foot. Plantar foot, forefoot and large size defects could be reconstructed with free flaps. Large defects with exposed bone/ implant with or without infection are best handled with a free flap.