Comparison of Free Muscle and Perforator Skin Flaps for Soft Tissue Reconstruction of the Foot and Ankle
Background: Free tissue transfer is generally required forreconstruction of soft-tissue defects of the foot and ankle regionbecause of the limited local tissue available. This type ofreconstruction may interfere with postoperative function andfootwear if a bulky flap is used. Materials and Methods: Twentynine patients had free tissue transfers to the foot and ankleregion during a period of 3 years. Sixteen had reconstructionwith free anterolateral thigh perforator flaps (ALT) and 13had reconstruction with free muscle flaps. The outcomes ofboth types of reconstructions were compared according to flapscores and complications, operative time, hospitalization, gaitand shoewear problems. Results: The patients in the ALT groupwere younger compared with those of the free muscle flapgroup (p = 0.022). The operative time and flap complicationrate was significantly higher (p = 0.007 and 0.040, respectively)in the ALT group. ALT was generally used for reconstructionof the dorsal foot, heel and plantar regions. Muscle flaps werepreferred in the ankle region, where open fractures of thetibia and fibula were frequently present, and for the patientswith increased risk of perioperative morbidity. Conclusion: FreeALT flap consisting of skin and adaptable subcutaneous tissue,both diminishes donor site morbidity and is ideally suited formost soft-tissue reconstruction of the dorsal foot, heel andplantar foot. Free muscle flaps, however, may offer relativelyless complicated tissue transfers and are preferred at the ankleregion in the presence of open tibia fractures, and in high riskpatients to decrease the perioperative morbidity.
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