The Reconstruction of Foot Soft Tissue Defects by Tangential Debulking of the Latissimus Dorsi Flap

ABSTRACT

Reconstruction of foot soft tissue is challenging particularly in the presence of a large defect involving both dorsal and plantar surfaces. In large defects, use of a latissimus dorsi muscle (LDM) flap is the preferred coverage method, yet LDM flaps are bulky. Despite undergoing multiple debulking procedures, patients whose feet are repaired with LDM flaps must wear oversized custom-made shoes. We developed an approach to allow patients to wear regular shoes. In six patients, we used a debulking procedure that was based on tangential trimming of the flap to the level of thickness required for normal foot contour. All patients underwent debulking 3 months after initial LDM flap coverage. The mean duration of follow-up care was 21 months (range, 8 to 32 months). All flaps survived a secondary debulking procedure. One patient developed an ulcer at the weight-bearing area of a sole. All six patients were able to wear regular shoes without difficulty.

KEYWORDS

Foot - soft tissue - reconstruction - free flap - debulking

REFERENCES

• 1 Rainer C, Schwabegger A H, Bauer T et al.. Free flap reconstruction of the foot.  Ann Plast Surg. 1999;  42 595-606 discussion 606-607
• 2 Bailey B N, Godfrey A M. Latissimus dorsi muscle free flaps.  Br J Plast Surg. 1982;  35 47-52
• 3 Lin T S, Jeng S F. Full-thickness skin graft as a one-stage debulking procedure after free flap reconstruction for the lower leg.  Plast Reconstr Surg. 2006;  118 408-412
• 4 Gould J S, Shi S M. Free vascularized soft tissue flaps for coverage of the foot and ankle.  Clin Orthop Relat Res. 1995;  (314) 26-36
• 5 Elliott L F, Raffel B, Wade J. Segmental latissimus dorsi free flap: clinical applications.  Ann Plast Surg. 1989;  23 231-238
• 6 Godina M. The tailored latissimus dorsi free flap.  Plast Reconstr Surg. 1987;  80 304-306
• 7 Hayashi A, Maruyama Y. The “reduced” latissimus dorsi musculocutaneous flap.  Plast Reconstr Surg. 1989;  84 290-295
• 8 Cassel J M. Intramuscular anatomy of the latissimus dorsi muscle.  Br J Plast Surg. 1989;  42 607-609
• 9 Rowsell A R, Godfrey A M, Richards M A. The thinned latissimus dorsi free flap: a case report.  Br J Plast Surg. 1986;  39 210-212
• 10 Chowdary R P, Murphy R X. Delayed debulking of free muscle flaps for aesthetic contouring debulking of free muscle flaps.  Br J Plast Surg. 1992;  45 38-41
• 11 Zook E G, Russell R C, Asaadi M. A comparative study of free and pedicle flaps for lower extremity wounds.  Ann Plast Surg. 1986;  17 21-33
• 12 Percival N J, Sykes P J, Earley M J. Free flap surgery: the Welsh Regional Unit experience.  Br J Plast Surg. 1989;  42 435-440