Arch Hand Microsurg.  2023 Jun;28(2):97-105. 10.12790/ahm.23.0004.

Comparison of fasciocutaneous and fascial anterolateral thigh free flaps in foot reconstruction

• Roh SY
• Park CJ
• Koh SH
• Kim JS
• Lee DC
• Lee KJ

• KMID: 2542560
• DOI: http://doi.org/10.12790/ahm.23.0004

Abstract

Purpose
This study compared the surgical outcomes and quality of life of patients who underwent fasciocutaneous and fascial anterolateral thigh (ALT) free flaps for the reconstruction of traumatic soft tissue defects in the foot.
Methods
A single-institution retrospective review of medical data from 2008 to 2021 was conducted on 20 patients who underwent a fasciocutaneous ALT free flap or fascial ALT free flap in the foot. Information was collected on patients’ baseline information, preoperative characteristics, and postoperative courses. Quality of life was measured through the Foot and Ankle Disability Index (FADI) score. A questionnaire survey was administered to evaluate aesthetic satisfaction and subjective improvement of dryness and sensory function at the surgical site.
Results
The mean flap dimensions were 13.96×4.58 cm and 10.75×3.50 cm in the fasciocutaneous and fascial groups, respectively. The overall flap failure and complication rates were higher in the fasciocutaneous group (total necrosis in one case, partial flap loss in two cases, and vascular complications in three cases). While aesthetic satisfaction and functional outcomes (FADI Sports) showed better outcomes in the fascial group, subjective improvement of dryness and sensory recovery showed better results in the fasciocutaneous group.
Conclusion
In comparison to fasciocutaneous flaps, fascial free flaps demonstrated lower rates of wound complications, higher aesthetic satisfaction, and better functional outcomes, but less improvement in dryness and sensory recovery at the flap site. Therefore, the choice of a flap for foot reconstruction should depend on the plastic surgeon’s discretion and a thorough discussion with the patient.

Keyword

Soft tissue defect; Foot defect; Microsurgery; Anterolateral thigh free flap; Free flap

Figure

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  Fig. 1. (A) A 36-year-old male patient sustained an injury to his left foot from a motor vehicle injury. Debridement and negative pressure wound therapy was applied, but tendons were exposed. (B) The defect was covered using an anterolateral thigh fascial free flap. (C) Postoperative photograph after flap insetting. (D) A split-thickness skin graft was performed after 4 weeks. Written informed consent was obtained from the patient above for the publication of this report including all clinical images.

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  Fig. 2. (A) A 68-year-old female patient sustained an injury to her right foot from a motor vehicle injury. (B) An anterolateral thigh fasciocutaneous flap was elevated. (C) Follow-up at postoperative follow-up. (D) Follow-up at postoperative 3 weeks. Written informed consent was obtained from the patient above for the publication of this report including all clinical images.

Reference

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