Experiences with fasciocutaneous flaps vs . muscle flaps as a cover of defects of the sole of the foot : analysis of the long-term clinical and functional results

Introduction: Reconstructing foot defects is a great challenge for plastic surgeons. The clinical and functional results (proprioceptive and exteroMax V. Meyer-Marcotty Jürgen Kopp ceptive) have been inconsistent for defect reconstructions on the weightKarina Sutmöller bearing and non-weight-bearing area of the foot. Moreover, no final Peter M. Vogt conclusion has been reached about the best type of flap to cover the defect on the weight-bearing area of the sole of the foot. It would be desirable to know whether the clinical and functional results and 1 Department of Hand-, Plastic Surgery and Reconstructive proprioceptive and exteroceptive qualities on the reconstructed foot provide a reliable indication of the long-term results after reconstruction of defects in the soft tissues in the loaded and unloaded foot. Surgery, Soest Hospital, Soest, Gemany Methods: This retrospective study contains the results from 23 of 39 patients who were operated on between 2001 and 2010. The mean 2 Department of Plastic Surgery and Hand Surgery, follow-up period was 46.6 months. In 10 patients with a defect cover Friederikenstift Hannover, Germany on the loaded sole of the foot, the clinical and functional parameters were compared for different flap plasties (muscle flap vs. fasciocu3 Department of Hand-, Plastic and Reconstructive Surgery, taneous flap). In addition, we examined the ability of all 23 patients to differentiate two points, hot and cold, and sharp and blunt, as well as vibration sensitivity in the reconstructed flap area. Hannover Medical School, Hannover, Germany Results:Nineteen (19) of the 23 patients (82.6%) could be reintegrated in their original occupations. The group of patients with a muscle flap on the loaded sole of the foot (Group 1) were kept in hospital for amuch longer period (67.6 days for Group 1 versus 22.2 days for Group 2 with a fascio-cutaneous flap to the loaded sole of the foot). In addition, the operation time was much longer in Group 1 than in Group 2 (485.3 min for Group 1 versus 296.6 min for Group 2). The rate of revision was 66.7% in Group 1 and 28.6% in Group 2. A single patient suffered ulceration in each of the two groups. The proprioceptive and exteroceptive qualities were independent of the type of flap and were essentially the same in the two groups. Discussion: Even though the perioperative parameters (operation-time, hospital-stay, rate of revision) were better in the group of patients with a fasciocutaneous flap to the weight-bearing area of the foot there was no evidence from our data for a clear correlation between ulceration and a loss of sensitivity to vibration. The long-term clinical and neurological results after covering a soft tissue defect in the foot are rather inconsistent, most of our patients (82.6%) could be reintegrated into their original occupations. What is decisive for optimal functional analysis after reconstruction of a soft tissue defect in the foot is not the clinical, perioperative and neurological investigation, but an analysis of the walking cycle with insole-pedobarography.