Sole reconstruction using anterolateral thigh perforator free flaps

Background: The goal of sole reconstruction should be functional and aesthetic. These goals can be achieved by providing the sole with a durable and comfortable weight-bearing surface, adequate contour, protective sensation, and solid anchoring to deep tissue to resist shearing. Various flaps such as fasciocutaneous, musculocutaneous, or split skin grafted muscle flaps have been reported for reconstruction of the weight-bearing foot. The perforator flap, however, deserves attention in the debate for the ideal flap because of its anatomical characteristics. Methods: Between June of 2002 and February of 2005, 69 patients were treated for soft-tissue defects in the plantar areas with anterolateral thigh perforator free flaps. Sensory nerve coaptation was performed in 17 cases. The follow-up period ranged from 4 to 38 months, with a mean of 14.7 months. Results: Satisfactory aesthetic and functional results were observed using 4- to 6-mm-thick anterolateral thigh perforator flaps. All flaps survived, with the exception of one case. Partial necrosis and dehiscence of the wound developed in three cases, but secondary healing was achieved and final outcome was not impaired. Partial weight bearing began at 3 weeks, and acceptable gait recovery was noted by 3 months as evaluated by clinical observation and gait analysis. Most patients regained protective sensation by 12 months regardless of nerve coaptation, but earlier sensory recovery was noted in patients who underwent reconstruction with sensate flaps. Conclusion: This article suggests the anterolateral thigh perforator flap to be a reliable option in sole reconstruction, resulting in an acceptable functional and aesthetic outcome.