PURPOSE: Soft tissue reconstruction of the hind-foot presents a reconstructive challenge, often requiring free tissue transfer. The ideal free flap has to provide thin, pliable tissue, achieve optimal contour and also withstand weight bearing.
METHODS: Free tissue transfers performed by a single surgeon for hind-foot reconstruction at a trauma center over three years were reviewed. The mechanism of injury, surgical and functional outcomes were recorded.
RESULTS: A total of 20 free tissue transfers were performed. Motor vehicle accidents were the most common injury mechanism (5/10), followed by falls (5/10) and ballistic wounds (4/10). The median interval from injury to reconstruction was 10 days. Twelve defects were covered with an anterolateral thigh flap; the remaining with muscle flaps (5 latissimus dorsi, 3 vastus lateralis). All arterial anastomoses were performed end-to-end and two recipient veins were used in each case. No total flap failures were encountered. Major complications included hematoma (1/20), soft tissue infection (3/20) and partial flap necrosis (1/20). Minor complications included delayed healing (1/20). Follow-up ranged from 2-28 months. Two patients required below knee amputation at 4 and 11 months after reconstruction, respectively; the remaining had a stable reconstruction at the completion of follow up.
CONCLUSION: Stable and durable hind-foot reconstruction is feasible with both fasciocutaneous and muscle flaps. Flap selection takes into consideration the defect location, underlying hardware and need for weight bearing. The complication rate remains high and a below knee amputation might be needed despite successful soft tissue reconstruction.