Soft tissue defects of the ankle and foot: Clinical profile and management.

Objectives: To study the etiologies and distribution of soft tissue defects over the ankle and foot, reconstructive procedures employed to provide cover of these defects, outcome, and the complications of various reconstructive procedures. Study Design: Retrospective and prospective Materials & Methods: All patients with soft tissue defects of ankle and foot, treated in the Department from Jan 1995 to July 2006, were evaluated for the etiology, site, histopathology of the lesions, size of the defects, any underlying illness and the reconstruction planned accordingly. Outcome of the reconstruction was assessed by regular follow-up. Results: Overall, 213 patients were studied with mean age of 37 years (range, 1-75 years). Male: female ratio was 2:1. Majority of the defects were on the weight bearing heel (35%); other predominant sites were dorsum of the foot (12%), dorsum of ankle (9%), forefoot (18%), posterior heel (8%) and circumferential foot & ankle (5%). Motor vehicular accidents accounted for the most common cause of the defects (38%); other causes were post tumor excision (25%), diabetes (16.7%), and burns (8.3%). Among the 55 patients with tumorous defects, 54.5% were squamous cell carcinomas, and 38% were malignant melanomas. Various modalities of the reconstruction were Distally based sural artery flap in 85 (40%) patients, Microvascular transfer of Latissimus dorsi, rectus abdominis and anterolateral thigh free flaps in 8 (3.7%) patients, flexor digitorum brevis muscle turnover flap with grafting in 12 (5.6%) patients, instep island flap in 3 patients, posterior tibial flap in 8 (3.7%) patients and instep rotation flap in 11 (5.1%) patients. Vacuum assisted closure (VAC) as a new modality of treatment was applied for reconstruction in 10 patients. There were only one complete flap necroses each in free flap and sural artery flap groups, 10 marginal/ partial necrosis and only two graft losses. They were managed by dressings, VAC and regrafting. Long-term results of the reconstruction were satisfactory. 90% of the patients were able to ambulate in their normal footwear. Half of the patients had protective sensations reconstruction was aesthetically acceptable to them. Conclusions: These reconstructive measures give the sufferers a good quality of life in the form of ambulation in a normal footwear and esthetically acceptable shape of the foot