Clin Orthop Surg.  2016 Dec;8(4):444-451. 10.4055/cios.2016.8.4.444.

Reconstruction of Postburn Contracture of the Forefoot Using the Anterolateral Thigh Flap

Affiliations
  • 1Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea. handsurgeon@naver.com

Abstract

BACKGROUND
Severe forefoot deformities, particularly those involving the dorsum of the foot, cause inconvenience in daily activities of living including moderate pain on the dorsal aspect of the contracted foot while walking and difficulty in wearing nonsupportive shoes due to toe contractures. This paper presents clinical results of reconstruction of severe forefoot deformity using the anterolateral thigh (ALT) free flap.
METHODS
Severe forefoot deformities were reconstructed using ALT flaps in 7 patients (8 cases) between March 2012 and December 2015. The mean contracture duration was 28.6 years.
RESULTS
All the flaps survived completely. The size of the flaps ranged from 8 cm × 5 cm to 19 cm × 8 cm. The mean follow-up period was 10 months (range, 7 to 15 months). There was no specific complication at both the recipient and donor sites. There was one case where the toe contracture could not be completely treated after surgery. All of the patients were able to wear shoes and walk without pain. Also, the patients were highly satisfied with cosmetic results.
CONCLUSIONS
The ALT flap may be considered ideal for the treatment of severe forefoot deformity.

Keyword

Forefoot; Foot deformities; Acquired; Microsurgical free flaps

MeSH Terms

Adult
*Burns/physiopathology/surgery
Child
*Contracture/physiopathology/surgery
Female
*Foot Injuries/physiopathology/surgery
Humans
Male
Middle Aged
Postoperative Complications
Reconstructive Surgical Procedures/*methods
Surgical Flaps/*surgery
Thigh/*surgery

Figure

  • Fig. 1 Case 1. (A–C) Dorsal post-burn scar contractures led to the development of dorsiflexion contractures of the toes (arrows). (D) All the contractures were debrided, and lengthening of the extensor digitorum longus was performed from the second to the fifth toes (black arrow). (E) The anterolateral thigh (ALT) flap was designed on the contralateral thigh. (F) The ALT flap was harvested in an oval shape and the pedicle length was 7 cm. (G) The skin defect was covered with a 12 cm × 5 cm ALT flap. (H–J) The radiograph and photographs obtained at 9 months after surgery show that the metatarsophalangeal and proximal interphalangeal joints of the fourth toe were stabilized with a plate (black arrow), and the flap survived well.

  • Fig. 2 Case 2. (A, B) A 61-year-old woman experienced a skin contracture on the right foot dorsum due to a chronic post-burn scar. All the toes exhibited a dorsal flexion deformity in the photograph and radiograph (arrows). (C) All the contracted tissues were debrided, and capsulotomy of the second metatarsophalangeal joint and extensor digitorum longus lengthening from the second to fourth toes were performed (black arrow). (D) The anterolateral thigh (ALT) flap was designed on the thigh. (E) The root of a perforating artery and a vein were ligated, and the ALT flap was raised. (F) The skin defect was covered with a 10 cm × 5 cm ALT flap. (G, H) Photograph and radiograph showing the recipient site at 7 months after surgery.


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