FLAP Foot Reconstruction

The foot is formed by several bones, ligaments, joints, and muscles, that function collectively to control various movements such as walking and running. The feet are susceptible to damage in the form of motor vehicle accidents, sports injuries, work-related trauma, and other reasons.

Flap foot reconstruction is a surgical procedure in which healthy, live tissue is transported from one area of your body (donor site) to your foot area (recipient site) that has lost skin, fat, muscle, or even bone, to correct the structures of the foot and restore the natural function of the foot that may have been lost due to a severe injury, fracture, or disease state.

Types of Flaps

There are many types of flaps that may be utilized, depending on the site of the flap and the foot structures that need to be repaired. Some of the common types include the following:

• Local flap: This type of flap is located next to the wound; the skin remains attached at one end to ensure that the blood supply is left intact.
• Regional flap: This type of flap utilizes a segment of tissue that is attached by a specific blood vessel.
• Bone/soft tissue flap: This is often used when bone and the overlying skin are transported to a new location.
• Musculocutaneous flap (muscle and skin flap): This type of flap is used when the site to be covered requires more mass and an increased blood supply.
• Microvascular free flap: This type of flap involves detaching and reattaching skin and blood vessels from one area of the body to another.

Indications

Your surgeon may recommend flap foot reconstruction to treat various foot disorders and restore your foot to its original health and function. Some of these disorders include:

• Deep wounds of the foot as a result of accident/trauma
• Birth defects such as clubfeet
• Plantar tissue defects
• Heel pad defects
• Infections
• Tumors and lesions
• Foot problems associated with metabolic diseases such as diabetes
• Athletic injuries such as Achilles tendon tears, foot/ankle fractures, and ligament injuries

Preparation

The pre-procedure preparation for flap foot reconstruction may involve the following:

• A review of your medical history and a physical examination
• Routine blood work and imaging
• Informing your doctor about medications or supplements you are taking
• Informing your doctor about any allergies to medications, anesthesia, or latex
• Disclosing any recent illnesses or other medical conditions
• Refraining from medications such as blood thinners and nonsteroidal anti-inflammatories, or other supplements, if contraindicated for the procedure
• Arranging for someone to drive you home after the procedure
• Signing an informed consent form

Surgical procedure

Flap foot reconstruction surgery is usually performed under general anesthesia. In general, the surgery involves the following steps:

• You will be placed in a supine (face-up) or a prone (face-down) position on the procedure table with your foot held in an optimal position to facilitate surgery.
• An incision is made over the area of the defect on the foot, and soft tissues are moved away to expose the treatment area.
• Using special instruments, your surgeon will carefully remove the damaged portions of the foot, and the area is prepared for placement of the suitable flap.
• Your surgeon will mark a specific area on the back of the body, such as the location of the latissimus dorsi muscle, which can be used for flap extraction.
• An incision is made across the selected site, and a flap of skin, fat, muscle, blood vessel, or bone is extracted.
• Your surgeon will transfer the removed flap to the area of the foot requiring reconstruction.
• Your surgeon will then perform the complex task of connecting the flap’s blood supply to the tiny blood vessels in the foot through microsurgery (using a microscope).
• At the end of the surgery, the incisions are closed with sutures, and a soft dressing pad is applied to the foot.

Postoperative care

In general, postoperative care instructions and recovery after flap foot reconstruction involve the following steps:

• You may experience pain, swelling, and discomfort in the foot area. Medications are provided as needed to address these.
• You are advised to keep your foot elevated as much as possible while resting to reduce swelling and pain.
• Applying ice packs to the foot several times a day is encouraged to reduce swelling and pain once medications are stopped.
• Your foot will be secured with a surgical shoe/sandal to facilitate wound healing, with instructions on restricted weight-bearing.
• Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
• Refrain from strenuous activities such as running and lifting heavy weights for a defined period.
• You should be able to resume your normal activities, such as walking, in a couple of months.
• Refrain from driving until you are fully fit and receive your doctor’s consent.
• Periodic follow-up appointments will be scheduled to monitor your progress.

Risks and Complications

Flap foot reconstruction is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following: 

• Damage to surrounding tissue
• Pain and discomfort
• Joint stiffness
• Infection
• Numbness
• Swelling and inflammation
• Flap failure
• Deep vein thrombosis (DVT) or blood clots

Summary

Flap foot reconstruction is a procedure where injured areas or defects of the foot are corrected by using flaps of tissue, skin, or bone, along with underlying blood vessels or muscles to rebuild the damaged foot structures. Reconstructive surgery on the foot is performed to improve the structural, functional, and cosmetic outcome of the injured foot.