title: Traumatic Forefoot Reconstructions With Free Perforator Flaps.
abstract: The forefoot is critical to normal walking; thus, any reconstruction of forefoot defects, including the soft tissues, must be carefully done. The free perforator flap, with its physiologic circulation, lower donor site morbidity, and minimal thickness is the most popular technique in plastic and microsurgery, and is theoretically the most suitable for such forefoot reconstruction. However, these flaps are generally recognized as more difficult and time-consuming to create than other flaps. In 41 patients with traumatic forefoot defects, we reconstructed the forefoot integument using 5 types of free perforator flaps. The overall functional and cosmetic outcomes were excellent. Three flaps required repeat exploration; one survived. The most common complications were insufficient perfusion and the need for second debulking. The key to our success was thoroughly debriding devitalized bone and soft tissue before attaching the flap. Forefoot reconstruction with a free perforator flap provides better function, better cosmesis, better weightbearing, and better gait than the other flaps we have used.
authors.affiliation: Surgeon, Orthopaedic Department, Kunming General Hospital of Chengdu Military Region, Kunming, China.
authors.forename: Yue-Liang
authors.initials: YL
authors.lastname: Zhu
authors.affiliation: Surgeon, Orthopaedic Department, Kunming General Hospital of Chengdu Military Region, Kunming, China.
authors.forename: Xiao-Qing
authors.initials: XQ
authors.lastname: He
authors.affiliation: Surgeon, Orthopaedic Department, Kunming General Hospital of Chengdu Military Region, Kunming, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Surgeon, Orthopaedic Department, Kunming General Hospital of Chengdu Military Region, Kunming, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Lv
authors.affiliation: Surgeon, Orthopaedic Department, Kunming General Hospital of Chengdu Military Region, Kunming, China.
authors.forename: Xin-Yv
authors.initials: XY
authors.lastname: Fan
authors.affiliation: Surgeon, Orthopaedic Department, Kunming General Hospital of Chengdu Military Region, Kunming, China. Electronic address: zhuyuelianghu@sina.com.
authors.forename: Yong-Qing
authors.initials: YQ
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D018409:Foot Injuries / Q000601:surgery*; D005545:Forefoot, Human / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap; D019651:Plastic Surgery Procedures; D017695:Soft Tissue Injuries / Q000601:surgery*; D055815:Young Adult
keywords: flap; forefoot; injury; plastic and reconstructive surgery; tissue loss