Management Strategies in Foot Reconstruction - Technical Pearls

Introduction: The reconstruction of the foot is complex as the requirement of the tissues is different depending on the function, size & site of the defect We have done more than 200 cases over 15 years duration at Hospital in District place in India. Our Hospital caters to the urban as well as rural population. The maximum number of cases are due to trauma. The incidence of lower extremity and foot trauma in India is very high due to the condition of the roads, the vehicles and the use of chappals or bare foot habbits.

Few case are due to infection, malignancy, diabetes and trophic ulcers.

Methodology and Material: We prefer the local or regional flaps in the smaller defects and whenever feasible. However the moderate to large size defects require the free flaps.

We use the Hindalco classification as the guidelines to choose the type of the flap for the reconstruction.

The smaller defects of the sole are covered by the local flaps. However muscle flap with graft is used for the reconstruction of the weight bearing sole while rest of the defects of the non-weight bearing area are covered predominantly with skin flaps.

Results: The survival rate of the flaps is comparable to the large series published in the literature. The results in respect to the cosmesis, function, durability are discussed in brief.

Conclusions: Local and regional flaps still have a major role in reconstruction of smaller defects in foot even though majority of our patients had larger size defects and underwent free flaps.