Reconstruction of the foot using microvascular flaps has been widely p
erformed in the last 15 years but the choice of flap to repair some ar
eas in the foot remains controversial. We present a series of 128 free
flaps to the foot performed during the period of 1975-1990. One hundr
ed and seventeen had a successful outcome (91%). The etiology of the p
roblem was traumatic in 94, congenital in 10, tumor in 9, and chronic
ulcerations due to vascular problems in 15. The indications for a spec
ific flap depended on the site and extension of the foot problem, and
were divided into four groups: 1. Dorsum of the foot. Cutaneous parasc
apular flap was the best choice. 2. The sole-weight-bearing area. We f
avored the use of the latissimus dorsi muscle flap covered with a spli
t thickness skin graft, done immediately. A proper tailoring of the fl
ap and postoperative care by the patient are very important to maintai
n the result without ulceration. Tactile sensation does not seem to be
essential. 3. The area over the calcaneus tendon. We have used cutane
ous flaps such as the parascapular and lateral arm flap or fascial fla
ps covered by split thickness skin grafts (STSG). The fascia used were
the serratus or the parascapular. 4. Complex trauma problems with ext
ensive skin loss or chronic ulcerations due to vascular diseases: the
latissimus dorsi musculocutaneous or muscle plus STSG was mostly used.
The overall number of donor areas were 5 groins, 48 parascapular, 2 g
luteal fold flaps, 4 lateral arm, 61 latissimus dorsi, and 8 fascial f
laps. (C) Wiley-Liss, Inc.