SLR - August 2012 - Jeff Merrill
Reference: Meyer-Marcotty MV, Sutmoeller K, Kopp J, Vogt PM. Postoperative Insole-Paedobarographic Gait Analysis for Patients with Flap Coverages of Weight-Bearing and Non-Weight-Bearing Areas of the Foot, J Plast Reconstr Aesthet Surg. 2012 Apr; 65(4): 482-8.
Scientific Literature Review
Reviewed by: Jeff Merrill, DPM
Residency Program: Pinnacle Health Hospitals
Podiatric Relevance:
Covering a defect on the plantar surface of the foot either from trauma or ulceration can be precarious because no tissue substitution can equate with the inherent properties of plantar skin. This study provides a means of evaluating plantar pressures following flap closures, and decisions regarding surgical reconstruction may or may not be affected by the results.
Methods:
Between 2001 and 2010, 39 patients were consented for inclusion in this study. Twenty-three of the patients were successfully followed with a mean time of 3.88 years. Nineteen of the cases were from trauma and four were from chronic ulcers secondary to burns or vascular problems. Flaps consisted of five sural, latissimus and parascapular flaps, four antero-lateral thigh flaps, two serratus flaps and one instep and radialis flap. Two patients required transmetatarsal amputations and one patient required multiple toe amputations.
Patients were divided into two groups. Group One were patients with weight-bearing flaps (consisting of 10 patients, but two were not able to undergo insole-paedobarographic gait analysis). Group Two were patients that received foot flaps that were in non-weight-bearing areas of the foot (13 total patients but one was unable to undergo insole-paedobarographic gait analysis).
Results:
Fifty percent of Group One flaps had to undergo revision while 62 percent of group 2 underwent revision. Two patients in Group One developed ulcerations in the plantar flap. All patients in Group One required modifications in shoe gear. In regards to the patient’s gait, comparison was made between the affected foot and sound foot in both groups as well as a comparison between the affected foot of Group One and Two. In Group One (plantar flap) there was a significant difference in the plantar pressures of the affected foot vs. the sound foot during contact (P=0.013) and midstance (P=0.008) phase of gait, but not the propulsion (P=0.94) phase. There was not a significant difference in the plantar pressures between the affected and sound foot in Group Two. There was a significant difference in the plantar midstance pressure between the affected foot of Group One and Group Two (P=0.043).
Conclusions:
The study presented is simple in both thought and design, but does provide evidence of the value of insole pedobarographic analysis following plastic surgery of the foot. This is especially true for plantar foot reconstruction where increased pressures and likelihood of new ulceration or recurrent ulceration can alter the surgical options for these patients.