Soft Tissue Coverage of the Foot and Ankle

CONTENTS I. Introduction ................................................................................................................... 266 II. Wound Evaluation ......................................................................................................... 266 III. Patient Evaluation .......................................................................................................... 266 IV. Mechanism ..................................................................................................................... 267 V. Wound Management Principles...................................................................................... 267 VI. Reconstruction ............................................................................................................... 267 VII. Nonoperative Treatment ................................................................................................ 267 VIII. Nonoperative Coverage of Foot and Ankle Wounds ..................................................... 268

A. Platelet-Derived Growth Factor (PDGF) ............................................................... 268

B. Topical Negative Pressure....................................................................................... 268

C. Hyperbaric Oxygen (HBO) ..................................................................................... 268 IX. Operative Treatment....................................................................................................... 268

A. Primary Closure ...................................................................................................... 269

B. Skin Grafts.............................................................................................................. 269

C. Local (Pedicle) Flaps............................................................................................... 269

1. Lateral Calcaneal Artery Flap.......................................................................... 269

2. Medial Plantar Flaps ........................................................................................ 271

3. Sural Fasciocutaneous Flap.............................................................................. 271

4. Flexor Digitorum Brevis................................................................................... 271

5. Extensor Digitorum Brevis ............................................................................... 271

6. Dorsalis Pedis ................................................................................................... 273

D. Free-Flap Reconstruction ....................................................................................... 273

1. Vascular Disease and Free-Tissue Transfer ...................................................... 274

2. Diabetes and Free-Tissue Transfer ................................................................... 274

3. Sensitivity and Foot and Ankle Reconstruction............................................... 274

4. Free Flaps and the Elderly ............................................................................... 275

5. Long-term Results of Free-Flap Foot Reconstruction ..................................... 275

6. Failures and Revisions...................................................................................... 275

7. Gait .................................................................................................................. 275

E. Specific Free Flaps .................................................................................................. 276

1. Radial Forearm Flap........................................................................................ 276

2. Rectus Abdominus ........................................................................................... 277

3. Latissimus Dorsi (LD)...................................................................................... 278

4. Parascapular ..................................................................................................... 279

5. Serratus Anterior.............................................................................................. 279

6. Gracilis ............................................................................................................. 279

7. Lateral Arm Flap ............................................................................................. 280

F. Other Flaps ............................................................................................................. 280 X. Conclusion...................................................................................................................... 282

Acknowledgment........................................................................................................................ 282 References .................................................................................................................................. 283

I. INTRODUCTION

Soft tissue coverage of foot and ankle wounds remains a challenging problem. The goal of soft tissue reconstruction is to achieve a stable, healed wound that is free of chronic infection and pain. Protective sensation and independent ambulation are also important outcome measures.