Soft tissue defects and chronic wounds around the foot and ankle can prove difficult to reconstruct using conventional techniques. Traditional flaps used for coverage in this region can result in the need for future debulking, shoe gear modifications, donor site morbidity, decreased function, and scarring. Successful reports of ultrathin free flaps harvested along suprafascial planes have yet to be described in the foot and ankle literature. We present 2 cases of ultrathin flaps used for foot and ankle defects that provide optimal contour while not limiting anatomic function. The resultant functional outcomes and contour shown by both flaps underscore the benefit of a thin and pliable flap in this region.
Level of Clinical Evidence
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The Journal of Foot and Ankle Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Survival following lower-limb amputation in a veteran population.Rehabil Res Dev. 2001; 38: 341-345
- Epidemiologic data of trauma-related lower limb amputees: a single center 10-year experience.Injury. 2017; 48: 349-352
- A cost-utility analysis of amputation versus salvage for Gustilo type IIIB and IIIC open tibial fractures.Plast Reconstr Surg. 2009; 124: 1965-1973
- The costs of diabetic foot: the economic case for the limb salvage team.J Vasc Surg. 2010; 52: 17-22
- National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States,.2014 (Centers for Disease Control and Prevention, Atlanta, GA:2014)
- Mind the gap: disparity between research funding and costs of care for diabetic foot ulcers.Diabetes Care. 2013; 36: 1815-1817
- One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities.Plast Reconstr Surg. 2004; 114: 1457-1466
- The role of early internal fixation in the management of open fractures.Clin Orthop Relat Res. 1979; 138: 120-131
- Acute and definitive management of traumatic osteocutaneous defects of the lower extremity.Plast Reconstr Surg. 1987; 80: 1-14
- Open fractures: evaluation and management.J Am Acad Orthop Surg. 2003; 11: 212-219
- Free tissue transfers and replantation.Plast Reconstr Surg. 2012; 130: 858e-878e
- Patient and surgical factors contributing to perioperative infection in complex lower extremity trauma.Am Surg. 2016; 82: 940-943
- The reconstruction of foot soft tissue defects by tangential debulking of the latissimus dorsi flap.J Reconstr Microsurg. 2011; 27: 211-214
- Comparison of free muscle and perforator skin flaps for soft tissue reconstruction of the foot and ankle.Foot Ankle Int. 2010; 31: 53-58
- Repair of the heel.Br J Plast Surg. 1961; 14: 117
- Resurfacing the sole: long-term follow-up and comparison of techniques.Br J Plast Surg. 1978; 31: 107
- Modified free radial forearm fascia flap reconstruction of lower extremity and foot wounds: optimal contour and minimal donor-site morbidity.J Reconstr Microsurg. 2014; 30: 515-522
- Super-thin and suprafascial anterolateral thigh perforator flaps for extremity reconstruction.J Reconstr Microsurg. 2017; 33: 466-473
- A new plane of elevation: the superficial fascial plane for perforator flap elevation.J Reconstr Microsurg. 2014; 30: 491-496
- Modified superficial circumflex iliac artery perforator flap and supermicrosurgery technique for lower extremity reconstruction: a new approach for moderate-sized defects.Ann Plast Surg. 2013; 71: 380-383
- The search for the ideal thin skin flap: superficial circumflex iliac artery perforator flap—a review of 210 cases.Plast Reconstr Surg. 2015; 135: 592-601
- Wound healing and diabetes mellitus.Clin Plast Surg. 2003; 30: 37-45
- Wound healing in patients with impaired kidney function.J Am Coll Clin Wound Spec. 2014; 5: 2-7
- The Society for Vascular Surgery lower extremity threatened limb classification system based on Wound, Ischemia, and foot Infection (WIfI) correlates with risk of major amputation and time to wound healing.J Vasc Surg. 2015; 61: 939-944
- Correlating patient-reported outcomes and ambulation success following microsurgical lower extremity reconstruction in comorbid patients.Microsurgery. 2014; 34: 1-4
- [Limb salvage or amputation after sever trauma to the lower extremities: evidence from the LEAP study].Unfallchirurg. 2016; 119: 400-407
- Evolution of the free groin flap: the superficial circumflex iliac artery perforator flap.Plast Reconstr Surg. 2007; 119: 1491-1498
- Supermicrosurgical free sensate superficial circumflex iliac artery perforator flap for reconstruction of a soft tissue defect of the ankle in a 1-year-old child.Microsurgery. 2016; 36: 254-258
- Quadruple-component superficial circumflex iliac artery perforator (SCIP) flap: a chimeric SCIP flap for complex ankle reconstruction of an exposed artificial joint after total ankle arthroplasty.J Plast Reconstr Aesthet Surg. 2016; 69: 1260-1265
- The versatility of the anterolateral thigh flap in lower extremity reconstruction.Handchir Mikrochir Plast Chir. 2009; 41: 193-202
Published online: April 06, 2019
Financial Disclosure: None reported.
Conflict of Interest: None reported.
© 2018 by the American College of Foot and Ankle Surgeons. All rights reserved.