ABSTRACT
Seventeen patients who underwent soft-tissue reconstruction of various anatomic regions
of the foot and ankle, using the radial forearm fasiocutaneous free flap, are reported.
The procedures were performed between January, 1992 and December, 1998. Indications
for reconstruction included diabetes and/or vascular insufficiency (four patients),
soft-tissue defects (six patients), 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 cm2 (mean: 86.2 cm2). 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 dehiscence at the flap-leg-skin interface (two patients). Recurrent
ulceration occurred in two patients; both were diabetics with weight-bearing flaps.
Donor-site complications included partial skin graft loss with tendon exposure in
one patient, which healed with conservative management. Recurrent or persistent osteomyelitis
was not demonstrated in any of the patients. Of the 16 patients with weight-bearing
flaps, 12 were ambulatory, three had limited ambulation, 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 anatomic prerequisites for an ideal foot
coverage; it also facilitates the restoration of normal foot contour, allowing patients
to wear ordinary shoes. The flap provides a durable and stable weight-bearing plantar
surface during ambulation, and achieves excellent aesthetic results; when used as
a neurosensory flap, it permits adequate reinnervation.
KEYWORD
Soft tissue defects - foot reconstruction - radial - forearm - fasciocutaneous free-tissue
transfer
