The Role of Local Flaps in Foot and Ankle Reconstruction: An Assessment of Outcomes across 206 Patients with Chronic Wounds.

Background: Reconstructive surgery has experienced a paradigm shift in favor of free flaps. Yet local flaps may be of particular use in foot and ankle reconstruction among comorbid patient populations. Thus, the authors sought to better characterize long-term outcomes in this setting.

Methods: A single-center, retrospective cohort study of patients undergoing local muscle and fasciocutaneous flaps of the foot and ankle from January of 2010 through November of 2022 was performed. Flaps were performed on wounds measuring 3 × 6 cm or smaller; flap selection depended on preoperative vascular assessment, Doppler findings, comorbidity profile, and wound location, depth, and geometry.

Results: A total of 206 patients met inclusion criteria. Their median age was 61.0 years (interquartile range, 16.8), and comorbidities included diabetes mellitus ( n = 149 [72.3%]) and peripheral arterial disease ( n = 105 [51.0%]). Presentations included chronic, nonhealing wounds ( n = 77 [39.1%]) or osteomyelitis ( n = 45 [22.8%]) and most frequently extended to the bone ( n = 128 [62.1%]). Eighty-seven patients (42.2%) received muscle flaps; 119 (57.8%) received fasciocutaneous flaps. Six patients (2.9%) needed return to the operating room, with thrombosis occurring in 2 cases (1.0%). The flap success rate was 98.1%. By a median follow-up duration of 21.7 months (interquartile range, 39.0), 21.8% of patients ( n = 45) required ipsilateral amputation, 73% ( n = 145 of 199) were ambulatory, and 2 deaths related to the surgical wound occurred (2 of 49 [4.1%]). Multivariate analysis revealed that positive predictors of complications included diabetes mellitus, end-stage renal disease, and history of venous thromboembolism or smoking.

Conclusion: Local flaps remain a reliable option to reconstruct smaller defects of the foot and ankle in a highly comorbid population.

Clinical question/level of evidence: Therapeutic, IV.