Long-term results of weight-bearing foot reconstruction with non-innervated and reinnervated free flaps

Twenty one patients underwent reconstruction of the weight-bearing portion of the foot with 22 free flap transfers: 12 free flaps were skin-grafted muscle flaps and 10 were fasciocutaneous flaps. Twelve flaps were reinnervated by nerve coaptation (n = 10) or an ‘onlay’ nerve graft (n = 2). Follow-up ranged from 1.5 to 7 years (mean 38.5 months). Five flaps (23%) developed full thickness ulcers that required surgical treatment. All ulcers occurred in patients who had an underlying neuropathy. Most complications occurred early in the series. No significant difference was found in the incidence of complications and functional outcome between fasciocutaneous and skin-grafted muscle flaps. There was no significant difference between reinnervated and non-innervated flaps. Both fasciocutaneous and skin-grafted muscle flaps, whether reinnervated or non-innervated, can be successfully used for weight-bearing foot reconstruction. Neither type of flap should be considered permanent in the presence of peripheral neuropathy. Appropriate selection of patients, extensive education about foot care and frequent follow-up visits are essential to maintain a healthy, intact flap and reconstructed foot.