Reconstruction of the Weight-Bearing Surface of the Foot with Nonneurosensory Free Flaps

Background The distal lower extremity poses unique reconstructive challenges due to its requirements for durability of the load-bearing plantar surface and for thin, pliable contour in the dorsal foot and ankle region. This study compares outcomes between muscle and fasciocutaneous flaps in patients with foot and ankle defects. Methods A retrospective review of soft tissue free flaps used for traumatic foot and ankle defects was performed. Outcomes included takebacks, partial flap failure, total flap failure, and wound complications. Results A total of 165 cases met inclusion criteria, with muscle flaps (n = 110) comprising the majority. Defects involving the non–weight-bearing surface were more common (n = 86) than those of the weight-bearing surface (n = 79). Complications occurred in 56 flaps (33.9%), including 11 partial losses (6.7%) and 6 complete losses (3.6%). There were no differences in take backs, partial flap failure, or total flap failure between muscle and fasciocutaneous flaps; however, fasciocutaneous flaps had significantly fewer wound complications compared with muscle flaps (7.3% vs. 19.1%, p = 0.046). On multivariable regression analysis, defects of the weight-bearing surface had significantly increased risk of wound breakdown compared with those in the non–weight-bearing surface (odds ratio: 5.05, p = 0.004). Conclusion Compared with fasciocutaneous flaps, muscle flaps demonstrated higher rates of wound complications. While the flap selection in foot and ankle reconstruction depends on the nature of the defect, our findings support the use of fasciocutaneous over muscle flaps in this region.

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Department of Clarification

Pediatrics in Review ◽

10.1542/pir.7.10.318 ◽

1986 ◽

Vol 7 (10) ◽

pp. 318-318

Keyword(s):

Weight Bearing ◽

Rapid Diagnosis ◽

Bearing Surface ◽

Simple Manner ◽

Plantar Surface ◽

Separate Category

Dr Allen L. Hoekman of Harrison, SD, has written as follows: I would appreciate clarification on an inconsistency I've noticed in William Weston's article, "Dermatoses of the Foot" (PIR 1985;7:45). On page 45 and in Table 2, it says that scabies does not involve the plantar surface of the foot. On page 49, it says that scabies can involve the plantar surface (weight-bearing surface). Please clarify. William L. Weston has replied: I agree with Dr Hoekman that it is confusing in the article as to whether or not the weight-bearing surface of the foot is involved in scabies. Clearly, involvement of the weight-bearing surface of the foot in scabies may occur, although the lesions occur predominantly over the dorsum of the foot and extend onto the ankle. For the purposes of making the algorithm in the article work in a simple manner, scabies was placed in this category to help with rapid diagnosis. However, it is clear that scabies can involve the weight-bearing surface of the foot; involvement of this area does not exclude the diagnosis. The algorithm would have perhaps been better if I had included a separate category for involvement of both the sole and the dorsum of the foot, but I believed this would have made the algorithm too complex.

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Inadequate thickness of the weight-bearing surface of claws in ruminants : clinical review

Journal of the South African Veterinary Association ◽

10.4102/jsava.v80i4.221 ◽

2009 ◽

Vol 80 (4) ◽

Cited By ~ 5

Author(s):

A.S. Shakespeare

Keyword(s):

Fresh Concrete ◽

Weight Bearing ◽

Frictional Coefficient ◽

Alkaline Ph ◽

Bearing Surface ◽

Dry Period ◽

White Line ◽

Protective Function ◽

Wear Rates ◽

Lactation Cycle

The term 'thin soles' refers to the suboptimal thickness of the weight-bearing surface of claws in ruminants. These palmar / plantar surfaces of the claws support the weight of the animal and consist of the distal wall horn, the sole proper, the heel and the minute white line area. The sole should normally only bear weight on uneven or undulating surfaces. A decrease in the thickness of the weight-bearing claw surface will decrease the protective function of this structure and may alter the proportion of weight-bearing by each section with possible detrimental effects on hoof function. Horn tissue readily absorbs water and becomes softer which can lead to increased wear rates. Growth rates normally match wear rates but, unlike the latter, time is needed for the growth rate response to adapt to changes in wear rate. Concrete surfaces can be abrasive and dairy cows that spend their lactation cycle on these floors should be let out to pasture in the dry period so that their claws can recoup lost horn. Frictional coefficient is a measure of the 'slipperiness' of hooves on various surfaces. Newly laid or fresh concrete is not only abrasive but the thin surface suspension of calcium hydroxide that forms has a very alkaline pH which causes keratin degradation and is mostly responsible for the excessive claw wear that occurs. Four case studies are used to illustrate the importance of the distal wall horn, the dangers of over-trimming and the effects of disease and concrete on horn growth and wear rates.

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Mosaic arthroplasty of the medial femoral condyle in horses — An experimental study

Acta Veterinaria Hungarica ◽

10.1556/avet.2013.059 ◽

2014 ◽

Vol 62 (2) ◽

pp. 155-168 ◽

Cited By ~ 8

Author(s):

Gábor Bodó ◽

Gábor Vásárhelyi ◽

László Hangody ◽

László Módis

Keyword(s):

Hyaline Cartilage ◽

Femoral Condyle ◽

Weight Bearing ◽

Medial Femoral Condyle ◽

The Other ◽

Bearing Surface ◽

Femoral Trochlea ◽

Osteochondral Grafts ◽

Mosaic Arthroplasty

One Arabian and 5 Hungarian half-bred horses were used to study the macroscopic and microscopic survival of autologous osteochondral grafts in the weight-bearing surface of the medial femoral condyle (MFC). Grafts were harvested from the cranial surface of the medial femoral trochlea (MFT) under arthroscopic control. Three of them were transplanted into the weight-bearing surface of the contralateral MFC using an arthrotomy approach. Three months later this transplantation procedure was repeated on the opposite stifle joints in the same animals, but at that time transplantation was performed arthroscopically. Follow-up arthroscopy was carried out 12 months after the first operations, and biopsies were taken from both the recipient and the donor sites for histological examination. During follow-up arthroscopy, the transplanted areas looked congruent and smooth. Microscopically, the characteristics of hyaline cartilage were present in 5 out of the 10 biopsies examined; however, in the other half of biopsies glycosaminoglycan (GAG) loss and change in the architecture of the transplanted cartilage was observed. In a 16-year-old horse, all grafts broke during harvesting, and thus transplantation was not performed. No radiological signs of osteoarthritic changes were detected 9 to 12 months after the operations in the donor and recipient joints. Clinically, no lameness or effusion was present three months after the transplantations.

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Sensate composite calcaneal flap in leg amputation: a full terminal weight-bearing surface—experience in eight adult patients

Strategies in Trauma and Limb Reconstruction ◽

10.1007/s11751-011-0118-z ◽

2011 ◽

Vol 6 (2) ◽

pp. 91-96 ◽

Cited By ~ 1

Author(s):

Bruno Livani ◽

Gabriel Castro ◽

Jose Roberto Tonelli Filho ◽

Tâmara Ramos Morgatho ◽

Mauricio Leal Dias Mongon ◽

...

Keyword(s):

Weight Bearing ◽

Adult Patients ◽

Bearing Surface ◽

Leg Amputation

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Sole Reconstruction Using Anterolateral Thigh Free Flap: A Review of 4 Cases

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v2i3.165 ◽

1970 ◽

Vol 2 (3) ◽

Author(s):

Parintosa Atmodiwirjo ◽

Afriyanti Sandhi

Keyword(s):

Free Flap ◽

Weight Bearing ◽

Donor Site ◽

Three Dimensional ◽

Free Flaps ◽

Donor Site Morbidity ◽

Common Procedure ◽

Anterolateral Thigh ◽

Protective Sensation ◽

And Function

Background: The ideal technique for sole reconstruction should meet such requisite as a durable and comfortable weight-bearing surface, solid anchoring to deep tissue for resistance to shear force and adequate protective sensation. The anterolateral thigh (ALT) perforator free flap provides a large, pliable skin island and sufficient bulk, allowing three-dimensional tailoring to complex defects. The present article is about our experience of sole reconstruction ALT perforator free flap. Patient and Method: Total of 4 flaps in the foot defects was performed in February 2009 to December 2012. We reconstructed soft tissue defects in the sole using ALT free flaps, the complications, aesthetic and function results were monitored. Result: ALT perforator free flap provided stable and durable long-term wound cover in all patients, resulting in early rehabilitation and function outcomes were completely achieved. Complications were few and manageable in all cases. Summary: ALT perforator free flap has become common procedure in many centers around the world. The numerous advantages include stable wound coverage; improve aesthetic and functional outcomes, and minimal donor site morbidity. In our experiences, we found that the use of ALT perforator free flap in sole defect reconstruction, to be technically affordable, reliable and have resulted in excellent outcomes.

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Digital pad transposition for replacement of the metacarpal or metatarsal pad in dogs

Journal of the American Animal Hospital Association ◽

10.5326/15473317-33-4-337 ◽

1997 ◽

Vol 33 (4) ◽

pp. 337-341 ◽

Cited By ~ 7

Author(s):

D Olsen ◽

RC Straw ◽

SJ Withrow ◽

AW Basher

Keyword(s):

Weight Bearing ◽

Severe Trauma ◽

Bearing Surface ◽

Clinical Cases

A technique for digital pad transposition is described and illustrated. This technique has application for use in cases of metacarpal or metatarsal pad neoplasia or severe trauma. The transposed digital pad will provide a weight-bearing surface of heavy, keratinized epidermis in cases where the normal metacarpal or metatarsal footpad has been removed. The use of the technique in four clinical cases of footpad neoplasia also is reported.

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