Combined pedicle and free-tissue transfer to improve functional restoration of the foot: The "backpack principle"

Reconstruction of weight-bearing areas of the foot remains a challenging pr oblem for the reconstructive surgeon. The principle described involves the combination of an innervated regional pedicle flap providing sensate, durab le coverage of the weight-bearing heel, and a microvascular fascia flap for thin, pliable coverage of a large surface defect, based on the same vascul ar bundle. This provides excellent long-term stability and minimizes the di sruption of blood supply to the foot. The result after 3 years demonstrates that this concept may represent an interesting solution for these particul ar problems.