Reconstruction of skin and soft-tissue defects of the foot: Challenges, techniques, and results. A retrospective-prospective observational study

Abstract

Background: Skin and soft tissue reconstruction of the foot is a complex undertaking owing to unique challenges and expectations. A comprehensive report of various techniques and the rationale of the choices is seldom found in the literature.

Aims and Objectives: To study various types of reconstructive challenges in the foot, the various techniques used to address them, and the results.

Materials and Methods: A retrospective-prospective observational study of skin and soft-tissue defects treated by the authors in the preceding 5 years was done. Medical records were retrieved. Follow-ups were conducted. The nature of defects, the reconstructive modalities used, and the outcomes were studied.

Results: A total of 28 cases of foot defects were studied. The most common causes were trauma and diabetic foot. Varying combinations of foot parts were involved, including plantar and dorsal surfaces. Repeated debridements and vacuum dressings were commonly used in preparation for resurfacing surgery. Peripheral angioplasty for improvement of blood flow was used in ischemic feet. Dermal regeneration templates were successful in carefully chosen difficult instances. Split-skin graft was commonly used for the dorsum of the foot. Pedicled and free microvascular flaps were used where bones, tendons, and weight-bearing soles were to be covered. Latissimus dorsi muscle flap with split-skin grafting was favored for weight-bearing sole reconstruction. At a minimum of 4 months of follow-up, all limbs were salvaged and functional. The median time for the return to the workplace was 3 months.

Conclusion: Reconstruction of the foot is an evolving field. The reconstructive surgeon needs to be abreast with the newer modalities of treatment, and an evaluation of the current practices should be a continuous process.