Use of dual-skin paddle anterolateral thigh perforator flaps in the reconstruction of complex defect of the foot and ankle

Abstract

Background: Complex soft tissue defect around the ankle and foot remains a reconstructive challenge for orthopedic and plastic surgeons. This study describes our clinical experience with the application of dual-skin paddle anterolateral thigh perforator (ALTP) flap for reconstruction of complex defects around the ankle and foot.

Methods: From June 2010 to June 2015, we retrospectively analyzed 15 patients with complex defects in the ankle and foot. Three types of soft tissue defects include irregular defect (n = 1), nonadjacent defect (n = 4), and extensive defect (n = 10). All patients in this series had exposure of underlying vital structures including vessels, nerves, bones, and tendons. All patients in this series underwent reconstruction with the dual-skin paddle ALTP flap.

Results: The dual-skin paddle ALTP flaps were successfully harvested to reconstruct three types of soft tissue defects in the ankle and foot. All the flaps survived. Only one flap had partial flap necrosis. One case suffered minor wound edge necrosis. All donor sites were closed directly and healed well. The mean follow-up time was 24.46 (range: 12-54) months. The average static two-point discrimination (s2PD) of the flap was 33 (range: 27-38) mm. The mean visual analog scale (VAS) score for the aesthetic appearance of the reconstructed defects was 8.9 (range: 8-9.5).

Conclusion: Our experience showed that the dual-skin paddle ALTP flap can provide two independent skin paddles for complex defect reconstruction while minimizing donor site morbidity. It is a reliable option for the reconstruction of complex defects in the ankle and foot.

Keywords: Anterolateral thigh perforator flap; Foot and ankle; Microsurgery; Soft tissue defect.