title: Reconstruction of Soft-Tissue Defects at the Foot and Ankle after Oncological Resection.
abstract: BACKGROUND
  Solid malignancies at the foot and ankle region are rare and include mainly soft-tissue sarcomas, bone sarcomas, and skin malignancies. Complete surgical resection with clear margins still remains the mainstay of therapy in these malignancies. However, attainment of negative surgical margins in patients with locally advanced tumors of the foot and ankle region may require extensive surgery and could result in loss of extremity function. In these circumstances, plastic surgical techniques can frequently reduce functional impairment and cover soft-tissue defects, particularly in cases of large tumor size or localization adjacent to critical anatomic structures, thereby improving the quality of life for these patients. The aim of this article is to illustrate the various treatment options of plastic surgery in the multimodal therapy of patients with malignant tumors of the foot and ankle region.
  
  
  METHODS
  This article is based on the review of the current literature and the evaluation of the author's own patient database.
  
  
  RESULTS
  The local treatment of malignant extremity tumors has undergone major changes over the last few decades. Primary amputations have been increasingly replaced by limb-sparing techniques, preserving extremity function as much as possible. Although defect coverage at the foot and ankle region is demanding due to complex anatomical features and functional requirements, several plastic surgical treatment options can be implemented in the curative treatment of patients with malignant solid tumors in this area. Soft-tissue defects after tumor resection can be covered by a variety of local flaps. If local flaps are not applicable, free flap transfers, such as the anterolateral thigh flap, parascapular flap, or latissimus dorsi flap, can be utilized to cover nearly all kinds of defects in the foot and ankle region.
  
  
  CONCLUSIONS
  Soft-tissue reconstruction in the foot and ankle region is a vital component of limb-sparing surgery. It enables complete resection of locally advanced tumors and subsequent adjuvant radiotherapy. Modern plastic surgical techniques should, therefore, be integrated in the multimodal treatment concept of malignancies in the foot and ankle region.
authors.affiliation: Department for Plastic and Hand Surgery, Burn Center/Sarcoma Reference Center, Ruhr-University Bochum , Bochum , Germany.
authors.forename: Andrej
authors.initials: A
authors.lastname: Ring
authors.affiliation: Department for Plastic and Hand Surgery, Burn Center/Sarcoma Reference Center, Ruhr-University Bochum , Bochum , Germany.
authors.forename: Pascal
authors.initials: P
authors.lastname: Kirchhoff
authors.affiliation: Department for Plastic and Hand Surgery, Burn Center/Sarcoma Reference Center, Ruhr-University Bochum , Bochum , Germany.
authors.forename: Ole
authors.initials: O
authors.lastname: Goertz
authors.affiliation: Department for Plastic and Hand Surgery, Burn Center/Sarcoma Reference Center, Ruhr-University Bochum , Bochum , Germany.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Behr
authors.affiliation: Department for Plastic and Hand Surgery, Burn Center/Sarcoma Reference Center, Ruhr-University Bochum , Bochum , Germany.
authors.forename: Adrien
authors.initials: A
authors.lastname: Daigeler
authors.affiliation: Department for Plastic and Hand Surgery, Burn Center/Sarcoma Reference Center, Ruhr-University Bochum , Bochum , Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Lehnhardt
authors.affiliation: Department for Plastic and Hand Surgery, Burn Center/Sarcoma Reference Center, Ruhr-University Bochum , Bochum , Germany.
authors.forename: Kamran
authors.initials: K
authors.lastname: Harati
keywords: flap; lower extremity; microsurgery; reconstructive surgical procedures; sarcoma