Instep split skin grafts on muscle flaps to reconstruct pressure exposed soft tissue parts at the lower extremity.
BACKGROUND
Reconstructed mechanically stressed zones of the lower extremity frequently suffer from problems such as hyperkeratotic edges or chronic ulcerations in the transition zone between conventional thigh skin grafts and normal skin. Defect coverage with skin grafts harvested from the instep region and placed on muscle flaps is not yet an established alternative.


METHODS
This is a retrospective study of a series of 12 clinical applications of soft tissue reconstruction at mechanically exposed zones of the lower extremity. Locally transposed or transplanted muscle flaps were covered with meshed instep skin instead of meshed thigh skin for the purpose to gain a superior stable skin surface and transition zones adjacent to normal skin.


RESULTS
There is no ulceration found at follow-up from 6 to 72 months. Only one case presented with delayed graft take. Different thicknesses of the corneal layers of the healed instep versus thigh skin grafts were verified histologically. Instep skin grafts showed substantial durability as well as advantageous aesthetic appearance with respect to texture and coloring. All donor sites healed without notable scars or sensitivity disorders.


CONCLUSIONS
The instep split skin graft is particularly well suited for defect coverage of muscle flaps transposed or transplanted to mechanically stressed zones of the foot or lower leg. The paramount advantage of transplanted instep skin as compared to thigh skin is given by the feasibility to create a durable graft with a thick horny layer and a stable transition zone at its periphery that is bordering normal skin.
Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. anton.schwabegger@i-med.ac.at
Anton H
AH
Schwabegger
Heinrich M
HM
Schubert
Mehmet
M
Baltaci
Gabriel
G
Djedovic
Timm O
TO
Engelhardt
Gerhard
G
Pierer
D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D000672:Amputation Stumps / Q000601:surgery*; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology*; D016038:Skin Transplantation; D013524:Surgical Flaps; D014947:Wounds and Injuries / Q000601:surgery*