SLR - May 2023 - Catherine Yun
Title: Reconstruction of Small-Sized Complex Defect on the Foot Dorsum Without Microsurgery: Intrinsic Adipofascial FlapReference: Choi SJ, Lee YH, Kim MB, Bae KJ, Kim S, Lee Y. Reconstruction of Small-Sized Complex Defect on the Foot Dorsum Without Microsurgery: Intrinsic Adipofascial Flap. International journal of lower extremity wounds. Published online 2023:15347346231154730-15347346231154730. doi:10.1177/15347346231154730
Level of Evidence: 3
Reviewed by: Catherine Yun
Residency Program: Community Medical Center, Toms River, NJ
Podiatric Relevance: I think this is a very interesting article that allows a podiatrist to be self-sufficient with good outcomes for dorsal foot defects with exposed bones or tendons. Reducing the needs for outside consultation that could aid in a quicker rate of healing with increased efficiency. The usage of intrinsic adipofascial flap procedure by rotating an adjacent adipofascial tissue to cover a small-sized dorsal foot defect gives better donor site morbidity and aesthetics, and supply recipient site with thin, adaptable, and pliable tissue for dorsal foot reconstruction.
Methods:
- Retrospectively reviewed intrinsic adipofascial flap for dorsal foot defect from May 2019 to January 2021 at their institution.
- Follow up 10 to 30 months, and average of 24.5 months.
- Inclusion criteria: 1) defect needed to be on the dorsal foot with bone or tendon exposed, 2) preoperative measurement of less than 4cm to the defect’s length or width, 3) have more than 6 months of clinical follow up.
- Exclusion criteria: 1) patients that received prior soft tissue surgery to the same foot, 2) patients with known neoplastic diseases in the same foot, 3) patients with suspicious acute soft tissue infection or osteomyelitis based on the preoperative radiographs, laboratory test, or bone scan.
- Primary outcomes for flap viability, ability to wear shoes, and donor site morbidity.
- Flaps designed adjacent to defect, preferably located around main arteries, such as medial tarsal artery, dorsal metatarsal artery, and lateral plantar artery.
Results: The study looked at 9 patients from the age of 48 through 86 years old whom had dorsal foot and ankle defects from 1.5 cm to 3.0 cm in width and from 1.5 cm to 3.0 cm in length that were treated with an intrinsic adipofascial flap. Eight of the 9 flaps survived and had an adequate foot contour for ordinary shoe wear. One of the 9 flaps with total necrosis, which had a larger defect 3.0 cm x 3.0 cm and the patient had peripheral arterial occlusive disease with no revascularization. Patients with surviving flaps had no problem with normal daily activity and normal shoe wear.
Conclusion: The intrinsic adipofascial flap is a good first surgical technique to perform for small dorsal foot defects as it is relatively easy to dissect. This technique provides a thin flap with minimal donor site morbidity, allowing for versatile rotation, adequate contour and durable cover while remaining cost effective.