Clinical analysis of repair of large skin defects in feet with flaps

Objective To analyze the clinical outcomes of three different type flaps (retrogressive flaps based on trunk vessel in leg, retrogressive cutaneous neurovascular island flaps, and free flaps) for repair of large skin defects in feet. Methods After thorough debridement,57 cases of large skin defects in feet were repaired by three different type flaps, including 14 cases of retrogressive flaps based on trunk vessel in leg with the average survive size of 8cm×16cm (7～ 9cm×11～20cm): 3 cases of retrogressive flaps based on posterior tibial artery, 11 cases of retrogressive flaps based on peroneal artery; 26 cases of retrogressive cutaneous neurovascular island flaps with the average survive size of 8cm× 11cm (7 ～9cm ×9 ～15cm): 23 cases of distal pedicle sural neurovascular island flaps and 3 cases of distal pedicle saphenous nerve neurovascular island flaps; 17 cases of free skin flaps with the average survive size of 12cm×25cm (9.5～15cm ×12～28cm): 13 cases of lateral thigh flaps,3 cases of arteria saphena flaps,and 1 case of thoracodorsal artery flap; and the clinical outcomes were observed. Results After 3 to 18 months follow -up, the flaps survived completely reveal sufficient blood supply, good shape, perfect texture and satisfactory outcome excluding 2 cases of complete necrosis (1 case of free skin flap and the other case of retrogressive flaps based on trunk vessel in leg) and 7 cases of distal marginal part necrosis (5 cases of distal pedicle nerve neurovascular island flaps and 2 cases of retrogressive flaps based on trunk vessel in leg). According to flap types, significant difference was between survive size (ANOVA,P=0.000),while no difference between survive ratio (Kruskal-Wallis Test,P=0.455). Conclusion Most skin defects of feet can be effectively repaired by distal pedicle cutaneous neurovascular island flaps, while if the defects encroached in forefeet especially when the defects size are comparatively large,free flaps should be strongly recommended.