Comparison of Free Muscle and Perforator Skin Flaps for Soft Tissue Reconstruction of the Foot and Ankle

Background: Free tissue transfer is generally required for reconstruction of soft-tissue defects of the foot and ankle region because of the limited local tissue available. This type of reconstruction may interfere with postoperative function and footwear if a bulky flap is used. Materials and Methods: Twenty-nine patients had free tissue transfers to the foot and ankle region during a period of 3 years. Sixteen had reconstruction with free anterolateral thigh perforator flaps (ALT) and 13 had reconstruction with free muscle flaps. The outcomes of both types of reconstructions were compared according to flap scores and complications, operative time, hospitalization, gait and shoewear problems. Results: The patients in the ALT group were younger compared with those of the free muscle flap group (p = 0.022). The operative time and flap complication rate was significantly higher (p = 0.007 and 0.040, respectively) in the ALT group. ALT was generally used for reconstruction of the dorsal foot, heel and plantar regions. Muscle flaps were preferred in the ankle region, where open fractures of the tibia and fibula were frequently present, and for the patients with increased risk of perioperative morbidity. Conclusion: Free ALT flap consisting of skin and adaptable subcutaneous tissue, both diminishes donor site morbidity and is ideally suited for most soft-tissue reconstruction of the dorsal foot, heel and plantar foot. Free muscle flaps, however, may offer relatively less complicated tissue transfers and are preferred at the ankle region in the presence of open tibia fractures, and in high risk patients to decrease the perioperative morbidity.