Radial forearm fasciocutaneous free-tissue transfer in ankle and foot reconstruction: Review of 17 cases

Seventeen patients who underwent soft-tissue reconstruction of various anat omic regions of the foot and ankle, using the radial forearm fasiocutaneous free flap, are reported. The procedures were performed between January, 19 92 and December, 1998. Indications for reconstruction included diabetes and /or vascular insufficiency (four patients), soft-tissue defects (six patien ts), and chronic osteomyelitis (seven patients). The weight-bearing surface of the foot was involved in 16 patients. Defects ranged in size from 35 to 206 cm(2) (mean: 86.2 cm(2)). At a mean follow-up of 3.8 years, the radial forearm flap was successful in all cases (100 percent). Flap complications included superficial infection (three patients), and minor wound dehiscenc e at the flap-leg-skin interface (two patients). Recurrent ulceration occur red in two patients; both were diabetics with weightbearing flaps. Donor-si te complications included partial skin graft loss with tendon exposure in o ne patient, which healed with conservative management. Recurrent or persist ent osteomyelitis was not demonstrated in any of the patients. Of the 16 pa tients with weight-bearing flaps, 12 were ambulatory, three had Limited amb ulation, and one was non-ambulatory. Three patients required modified shoes . No debulking of the transferred flaps was necessary. The radial forearm flap is one of the preferred flaps for reconstruction of moderate-sized ankle and foot defects, for weight-bearing surfaces, and in the treatment of osteomyelitic and diabetic wounds. It meets most of the a natomic prerequisites for an ideal foot coverage; it also facilitates the r estoration of normal foot contour, allowing patients to wear ordinary shoes . The flap provides a durable and stable weight-bearing plantar surface dur ing ambulation, and achieves excellent aesthetic results; when used as a ne urosensory flap, it permits adequate reinnervation.