Long-Term Results of a One-Stage Secondary Debulking Procedure after Flap Reconstruction of the Foot

Background: Free or local flaps that are used to reconstruct the foot are often associated with a multitude of problems, most with regard to poor aesthetic and functional outcomes. This is because of the bulkiness of the flap and its difference from the native glabrous skin of the weight-bearing region of the foot. Although these can be improved using various debulking procedures, the results are not satisfactory. Methods: From January of 2002 to July of 2014, one-stage debulking procedures were performed for 42 feet after flap reconstructions. Twelve patients (28.6 percent) had bulky flaps over the weight-bearing area of the foot compared with 30 (71.4 percent) on the non-weight-bearing area. The functional and cosmetic outcomes were reviewed after 12-month follow-up. Results: The overall mean follow-up time was 20 months. All the grafted skin took well, except for partial superficial skin necrosis, which healed by secondary intention, and one skin loss that needed further skin grafting. The patients were able to dress in their preinjury shoes without any difficulty and with ease of ambulation because of improvement in skin stability. The skin sensation and texture of the reconstructed feet matched the normal sides well. No long-term ulceration was noted. All of the patients were satisfied with the results. Conclusion: A one-stage debulking procedure can provide long-term constant, reliable, thin skin coverage for the feet after free flap or local flap reconstruction.