Sole Reconstruction Using Anterolateral Thigh Perforator Free Flaps

The goal of sole reconstruction should be functional as well as aesthetic—a durable and comfortable weight- bearing surface, adequate contour, protective sensation, and solid anchoring to deep tissue to resist shearing. The anterolateral thigh perforator free flap is one of the most versatile options for soft tissue coverage. With technical refinements, this flap can be thinned to 3–4 mm or can be elevated with sufficient bulk with muscles like the vastus lateralis.

Between June 2002 and December 2004, 48 patients were treated for soft tissue defects in plantar areas with anterolateral thigh perforator free flaps. The follow up-period ranged from 4 to 34 months, with a mean of 14.7 months. With the exception of one case, all flaps survived. Partial necrosis developed in three cases, but was treated conservatively. Satisfactory aesthetic and functional results were achieved, and acceptable gait recovery was also noted by clinical observation and gait analysis. Most patients regained protective sensation by 6 months, and earlier recovery was noted in the sensate flap group.

The authors suggested that this flap presents a reliable option in sole reconstruction. With proper preoperative patient evaluation and standardized postoperative management, flap failure and complication can be minimized.