Microsurgical Foot Reconstruction Using Endoscopically Harvested Muscle Flaps

내시경 피판채취법을 이용한 미세수술적 족부 재건

  • Woo, Kyong-Je (Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine) ;
  • Lim, So-Young (Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine) ;
  • Pyon, Jai-Kyong (Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine) ;
  • Bang, Sa-Ik (Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine) ;
  • Oh, Kap-Sung (Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine) ;
  • Mun, Goo-Hyun (Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine)
  • 우경제 (성균관대학교 의과대학 성형외과학교실) ;
  • 임소영 (성균관대학교 의과대학 성형외과학교실) ;
  • 변재경 (성균관대학교 의과대학 성형외과학교실) ;
  • 방사익 (성균관대학교 의과대학 성형외과학교실) ;
  • 오갑성 (성균관대학교 의과대학 성형외과학교실) ;
  • 문구현 (성균관대학교 의과대학 성형외과학교실)
  • Received : 2010.05.10
  • Accepted : 2010.07.19
  • Published : 2010.09.10

Abstract

Purpose: Reconstruction of soft tissue defects of the foot often requires free-flap transfer. Free muscle flap transfer and skin grafts on the muscle has been an option for these defects. Here we present our experiences of foot reconstruction using an endoscopy-assisted free muscle flap harvest. Methods: Using endoscopy-assisted free muscle flap harvests, four patients with soft tissue defects of the foot were treated with a free muscle flap and skin graft. The gracilis muscle was used for two patients and the rectus abdominis muscle for two. A single small transverse skin incision was placed on the lower abdomen for the rectus abdominis muscle. A small transverse skin incision on the proximal thigh was the only incision for harvesting the gracilis muscle flap. The small incisions were enough for the muscle flap to be pulled through. Results: The flaps survived successfully in all cases. Contours were good from both functional and aesthetic aspects. No breakdowns or ulcerations of the flap developed during long-term follow-up. Resultant scars were short and relatively hidden. Functional morbidities such as abdominal bulging were not noted. Conclusion: Endoscopy-assisted harvest of muscle flap and transfer with skin graft is a good option for soft tissue defects of the foot. Morbidities of the donor site can be minimized with endoscopic flap harvest. This method is preferable for young patients who want a small donor site scar.

Keywords

References

  1. Harris PG, Letrosne E, Caouette-Laberge L, Egerszegi EP: Long term follow-up of coverage of weight bearing surface of the foot with free muscular flap in a pediatric population. Microsurgery 15: 424, 1994 https://doi.org/10.1002/micr.1920150611
  2. May JW Jr, Rohrich RJ: Foot reconstruction using free microvascular muscle flaps with skin grafts. Clin Plast Surg 13: 681, 1986
  3. Ferreira MC, Besteiro JM, Monteiro Junior AA, Zumiotti A: Reconstruction of the foot with microvascular free flaps. Microsurgery 15: 33, 1994 https://doi.org/10.1002/micr.1920150110
  4. Sonmez A, Bayramicli M, Sonmez B, Numanoglu A: Reconstruction of the weight-bearing surface of the foot with nonneurosensory free flaps. Plast Reconstr Surg 111: 2230, 2003 https://doi.org/10.1097/01.PRS.0000062564.35426.07
  5. Reath DB, Taylor JW: The segmental rectus abdominis free flap for ankle and foot reconstruction. Plast Reconstr Surg 88: 824, 1991 https://doi.org/10.1097/00006534-199111000-00013
  6. Lin CH, Wei FC, Lin YT: Conventional versus endoscopic free gracilis muscle harvest. Plast Reconstr Surg 105: 89, 2000 https://doi.org/10.1097/00006534-200001000-00015
  7. Schoeller T, Wechselberger G, Hussl H, Otto-Schoeller A, Bauer T, Piza-Katzer H: Aesthetic improvements in endoscopic gracilis muscle harvest through a single transverse incision in the groin crease. Plast Reconstr Surg 110: 218, 2002 https://doi.org/10.1097/00006534-200207000-00038
  8. Lin CH, Wei FC, Lin YT, Su CI: Endoscopically assisted fascia-saving harvest of rectus abdominis. Plast Reconstr Surg 108: 713, 2001 https://doi.org/10.1097/00006534-200109010-00018
  9. Lin CH, Wei FC, Levin LS, Chen MC: Donor-site morbidity comparison between endoscopically assisted and traditional harvest of free latissimus dorsi muscle flap. Plast Reconstr Surg 104: 1070, 1999 https://doi.org/10.1097/00006534-199909040-00027