SLR - April 2023 - Anjni Patel, DPM
Title: Reconstruction of Foot and Ankle Defects Using Free Lateral Arm Flap: A Retrospective Review of Its Versatile ApplicationReference: Kim JH, Yoon T, Park JK, Eun S. Reconstruction of Foot and Ankle Defects Using Free Lateral Arm Flap: A Retrospective Review of Its Versatile Application. Biomed Res Int. 2021 Oct 31;2021
Level of Evidence: Level IV
Scientific Literature Review
Reviewed by: Anjni Patel, DPM
Residency Program: Rochester General Hospital – Rochester, New York
Podiatric Relevance: Soft tissue defects of the lower extremity from numerous pathologies are difficult to treat and positive long-term outcomes are infrequent due to the complex medical histories and comorbidities that are often times associated with podiatric patients. Reconstruction is difficult due to inadequate blood supplies as well as compromised structural integrity and the limited availability of local tissues. Despite many efforts made by podiatric surgeons, some patients may require more innovative treatment options and collaboration with other specialties, such as plastic surgery, for improved patient outcomes. The goal of this article was to present the use of free lateral arm flaps (LAF) to reconstruct foot and ankle soft tissue deficits caused by different etiologies.
Methods: This is a retrospective study that was performed at Seoul National University Bundang Hospital from May 2011 to May 2020. There was a total of 20 patients, 8 men and 12 women, with a mean age of 66.8 (range, 48–89) years. Etiologies included chronic osteomyelitis and ulcers (9), malignant melanoma (4), diabetic foot (3), trauma (3), and burn injury (1). Lateral arm flaps with sensate, extended, osteomyocutaneous, or myocutaneous flaps were utilized as indicated for each patient. The two-point discrimination test was used in sensate flaps.
Results: There were 16 fasciocutaneous LAFs, 2 extended fasciocutaneous LAFs, 1 myocutaneous LAF and 1 osteomyocutaneous free LAF. Sensate LAF were utilized for plantar defects. In the two-point sensory discrimination test, the distinguishable distance in sensate flaps was 19.1 ± 4.9mm, while in the non-sensate flaps it was 28.9 ± 4.2mm. These results were statistically significant (p < 0.05). The mean follow-up period was 18.2 months. The size range of the LAF was 12 – 108 cm2, with an average of 48.7 cm2 and a maximum length of 9 cm. Complications included 2 flap congestions and 3 partial flap necroses. All complications were resolved with vein reanastomosis, STSGs, flap readvancement or flap debulking. No cases of flap failure or donor site complications were reported.
Conclusions: Despite the differences in etiologies of the defects as well as the comorbidities that prevent wound healing, this case series presents a viable option for soft tissue coverage of the lower leg, ankle, and dorsal and plantar foot. Although complications occurred, the flaps were salvageable, and the donor sites remained stable with primary closure. Additionally, the recipients of the sensate flaps had more adequate sensory function which has shown to provide better long-term outcomes when used to reconstruct the weight-bearing surface as it aids in the prevention of re-ulcerations. The potential benefits the LAF provides for podiatric patients is discernable with this study however limitations such as small sample size and short follow up times allow for further research opportunities. In the future, it would be advantageous to compare the outcomes of the LAF to local flaps, how the flap behaves in re-ulceration cases and further analysis in the differences of each subcategory of the LAF flap. Lateral arm flaps have a probable use in podiatric medicine to provide satisfactory patient outcomes in partnership with plastic surgery.