Comparison of instep and non-instep flap in the reconstruction of the weight-bearing portion of the forefoot and heel

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-07-06 DOI:10.1002/micr.31209
Jae Hoon Lee MD, PhD, Ki Hyeok Ku MD, Jin Hyung Kim MD, Jong Hun Baek MD, PhD
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引用次数: 0

Abstract

Background

Instep flaps are commonly used for the reconstruction of weight-bearing areas of the foot. However, in cases of large defects or damage to the instep area, non-instep flaps such as reverse sural flaps (RSF) or free anterolateral thigh flaps (ALTF) can be employed. Previous studies have primarily focused on heel reconstruction when comparing different flaps, without considering the forefoot. This study aims to verify the clinical outcomes of these flaps and determine the appropriate donor site for weight-bearing areas of the foot including forefoot reconstruction.

Methods

In a retrospective study, 39 patients who had undergone flap reconstruction of weight-bearing area defects in the foot with a follow-up period of ≥1 year were included. The patients were categorized into two groups: Group A (n = 19) using instep flaps, and Group B (n = 20) using non-instep flap including RSFs and ALTFs. Surgical outcomes were assessed based on the success of the flap, the presence of partial necrosis, the number of additional surgeries, and complications related to the donor site. Clinical evaluation included visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score, and the occurrence of ulcers.

Results

All flaps were successful, while partial necrosis occurred in one case in Group B. There were three reclosures after flap border debridement in both groups and one donor site debridement in Group A. The VAS scores during weight-bearing were 2.0 ± 1.1 and 2.2 ± 1.5 for Groups A and B, respectively (p = .716). The AOFAS scores were 52.8 ± 6.8 and 50.2 ± 12.7 for Groups A and B, respectively (p = .435). The occurrence of ulcers was 0.4 ± 0.9 times for Group A and 0.3 ± 0.7 times for Group B, with no significant difference between the two groups (p = .453).

Conclusion

There was no difference in clinical outcomes between the types of flaps after reconstruction of the forefoot and hindfoot. Therefore, it is recommended to choose the appropriate flap based on factors such as the size of the defect, its location, and vascular status rather than the type of flap.

Abstract Image

在重建前脚掌和脚跟的负重部分时,比较脚背瓣和非脚背瓣。
背景:脚背皮瓣通常用于重建足部的负重区域。然而,在脚背区域有大面积缺损或损伤的情况下,可以使用非阶梯皮瓣,如反向鞍瓣(RSF)或游离大腿前外侧皮瓣(ALTF)。以往的研究在比较不同皮瓣时主要关注足跟重建,而未考虑前足。本研究旨在验证这些皮瓣的临床效果,并确定包括前足重建在内的足部负重区域的合适供体部位:在一项回顾性研究中,纳入了 39 名接受过足部负重区缺损皮瓣重建术且随访时间≥1 年的患者。患者分为两组:A 组(n = 19)使用脚背皮瓣,B 组(n = 20)使用非脚背皮瓣,包括 RSFs 和 ALTFs。手术结果根据皮瓣的成功率、是否出现部分坏死、额外手术次数以及与供体部位相关的并发症进行评估。临床评估包括视觉模拟量表(VAS)、美国骨科足踝协会(AOFAS)评分以及溃疡发生情况:A组和B组在负重时的VAS评分分别为(2.0 ± 1.1)和(2.2 ± 1.5)(P = .716)。A 组和 B 组的 AOFAS 评分分别为 52.8 ± 6.8 和 50.2 ± 12.7(p = .435)。A 组溃疡发生率为 0.4 ± 0.9 次,B 组为 0.3 ± 0.7 次,两组间无显著差异(p = .453):结论:重建前足和后足后,不同类型皮瓣的临床疗效无差异。因此,建议根据缺损的大小、位置和血管状况等因素选择合适的皮瓣,而不是皮瓣的类型。
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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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