V-Y Fasciocutaneous Advancement Flap Coverage of Soft Tissue Defects of the Foot in the Patient at High Risk

Abstract 

This single-center, observational case series involved a review of prospectively collected data pertaining to 16 V-Y fasciocutaneous advancement flaps performed on 16 consecutive patients between August 2006 and December 2008. Each patient underwent primary excision of a foot ulcer with debridement of soft tissue and bone, insertion of polymethylmethacrylate antibiotic–loaded bone cement, and immobilization. At an average of 3 days after the index procedure, soft tissue and osseous deformities were corrected in 13 of the 16 patients, and a V-Y fasciocutaneous advancement flap was used for coverage of the soft tissue defect in all patients. Patients were kept nonweightbearing and were followed up until clinical healing occurred or failure was declared. There were 12 male and 4 female patients with a mean age of 64.0 ± 7.4 years (range, 48–75 years). Fifteen patients had diabetes mellitus with a mean of 5.1 ± 1.8 (range, 3–8) medical comorbidities. There were 10 medial forefoot, 3 central forefoot, 2 lateral forefoot, and 1 dorsal midfoot full-thickness soft tissue defects that displayed a mean diameter of 2.3 ± 1.4 cm (range, 1.0–3.5 cm). All but 4 flaps healed primarily, with each developing marginal dehiscence that healed with local wound care measures. Two deep infections occurred despite healing of the flap, which necessitated transmetatarsal amputation with split-thickness skin graft coverage. When properly performed and after complete resolution of infection, V-Y fasciocutaneous advancement flap coverage of complex foot ulcerations represents a useful and reliable technique even in patients with multiple medical comorbidities.

Level of Clinical Evidence: 4

Keywords: amputation, diabetes, foot, noncompliance, ulceration