title: Instep free flap for plantar soft tissue reconstruction: indications and options.
abstract: Pedicled instep flaps are frequently used in weight-bearing plantar reconstruction, but may not be available after severe foot injuries. Although free instep flaps offer a viable option, they have scarcely been reported. A posttraumatic plantar forefoot defect was reconstructed with a sensate, instep free flap, because local flaps were not available and defect size did not require a distant free flap, and the current literature was reviewed for therapeutic options. The instep free flap yielded an excellent functional and aesthetic long-term result. In the literature, pedicled instep flaps are advocated for moderate size defects of the weight-bearing heel and sole, while free flaps from distant sites are preferred for large defects. Although skin-grafted muscle flaps and fasciocutaneous flaps yield similar results, reconstruction by like tissues appears favorable. We suggest the instep free flap for weight-bearing plantar foot reconstruction, when pedicled instep flaps are not available and distant free flaps are avoidable.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basil, Switzerland. oscheufler@uhbs.ch
authors.forename: Oliver
authors.initials: O
authors.lastname: Scheufler
authors.forename: Daniel
authors.initials: D
authors.lastname: Kalbermatten
authors.forename: Gerhard
authors.initials: G
authors.lastname: Pierer
mesh_terms: D005260:Female; D018409:Foot Injuries / Q000601:surgery*; D005684:Gait; D006801:Humans; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps