Microsurgical Reconstruction of the Plantar Foot: Long-Term Functional Outcomes and Quality of Life

Background When faced with plantar defects, reconstruction of the weight-bearing areas presents unique surgical challenges. Several free flap modalities have been described in this respect, but there remains debate regarding the best-suited flap modality. Aim of this study was to compare free muscle and non-neurotized fasciocutaneous flaps for plantar reconstruction with respect to long-term functional outcomes. Methods Overall, 89 patients received 100 free flaps (anterolateral thigh [ALT] n =46; gracilis n =54) for plantar reconstruction. The data were screened for patients' demographics, as well as perioperative details. Postoperative complications were accounted for and the two groups compared accordingly. All patients were contacted for a long-term follow-up examination. Results There were no significant differences between the two groups regarding major (24 vs. 17%; p =0.366) and minor surgical complications (61 vs. 70%; p =0.318). However, the ALT group showed a significantly higher need for secondary surgeries (39 vs. 19%; p =0.022). Sixty-eight patients (76%) returned for long-term follow-up evaluation (mean: 51.2 months, range: 13-71 months). The ALT group showed significantly less pain at the recipient (p =0.0004) and donor ( p =0.010) sites, and scar assessment revealed significantly better results ( p