CLINICAL ARTICLE

Virtual planning of the anterolateral thigh free flap for heel reconstruction

Mohamed A. Ellabban MD

orcid.org/0000-0003-3723-4604

Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

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Malek A. Elsayed MSc, MRCS (Eng),

Malek A. Elsayed MSc, MRCS (Eng)

Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

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Abo Bakr Zein MD,

Abo Bakr Zein MD

Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Cairo University, Giza, Egypt

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Mohamed Ghorab MSc,

Mohamed Ghorab MSc

Department of Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Giza, Egypt

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Moustafa Elmasry MD,

Moustafa Elmasry MD

Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden

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Suhail Masadeh DPM,

Suhail Masadeh DPM

Podiatric Surgery Unit, Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA

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Mohamed Mokhtar Abo-Ella MD,

Mohamed Mokhtar Abo-Ella MD

Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

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Ahmed Fathy Sadek MD,

Corresponding Author

Ahmed Fathy Sadek MD

orcid.org/0000-0001-5956-137X

Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Minia University, Minya, Egypt

Correspondence

Ahmed Fathy Sadek, Hand and Microsurgery Unit, Orthopaedic Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt.

Email: [email protected] and [email protected]

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Mohamed A. Ellabban MD,

Mohamed A. Ellabban MD

orcid.org/0000-0003-3723-4604

Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

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Malek A. Elsayed MSc, MRCS (Eng),

Malek A. Elsayed MSc, MRCS (Eng)

Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

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Abo Bakr Zein MD,

Abo Bakr Zein MD

Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Cairo University, Giza, Egypt

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Mohamed Ghorab MSc,

Mohamed Ghorab MSc

Department of Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Giza, Egypt

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Moustafa Elmasry MD,

Moustafa Elmasry MD

Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden

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Suhail Masadeh DPM,

Suhail Masadeh DPM

Podiatric Surgery Unit, Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA

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Mohamed Mokhtar Abo-Ella MD,

Mohamed Mokhtar Abo-Ella MD

Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

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Ahmed Fathy Sadek MD,

Corresponding Author

Ahmed Fathy Sadek MD

orcid.org/0000-0001-5956-137X

Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Minia University, Minya, Egypt

Correspondence

Ahmed Fathy Sadek, Hand and Microsurgery Unit, Orthopaedic Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt.

Email: [email protected] and [email protected]

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First published: 01 April 2022

https://doi.org/10.1002/micr.30886

Citations: 1

Funding information: This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

[Correction added on April 06, 2022, after first online publication: Degree of Suhail Masadeh has been corrected.]

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Abstract

Purpose

three dimensional (3-D) virtual planning is an example of computer assisted surgery that improved management of composite tissue defects. However, converting the 3-D construct into two dimensional format is challenging. The purpose of this study was to assess 3-D virtual planning of complex heel defects for better optimized reconstruction.

Patients and methods

a prospective analysis of 10 patients [9 male and 1 female; mean age = 27.9 years] with post-traumatic heel defects was performed. Heel defects comprised types II (three patients) or III (seven patients) according to Hidalgo and Shaw and were managed using anterolateral thigh (ALT) free flap adopting 3-D virtual planning of the actual defect which was converted into a silicone two dimensional mold. The mean definitive size of the defects was 63.4 cm³. Functional, aesthetic, and sensory evaluations of both donor and recipient sites were performed 1 year after surgery.

Results

Six patients received thinned ALT (mean size = 139 cm³) while four patients received musculofasciocutaneous ALT flap (mean size = 199 cm³). One flap exhibited partial skin flap necrosis. Another flap was salvaged after re-exploration secondary to venous congestion. The mean follow-up was 20.2 months. The Maryland foot score showed 4 excellent, 5 good, and 1 fair cases. The mean American Orthopedic Foot and Ankle hind foot scoring was 76.3 (range: 69–86). All patients regained their walking capability.

Conclusions

3-D virtual planning of complex heel defects facilitates covering non-elliptical defects while harvesting a conventional elliptical flap with providing satisfactory functional outcomes and near-normal contour, volume, and sensibility.

CONFLICT OF INTEREST

All authors declare that they have no conflicts of interest.

Open Research

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

REFERENCES

Agostini, T., Lazzeri, D., & Spinelli, G. (2014). Anterolateral thigh flap thinning: Techniques and complications. Annals of Plastic Surgery, 72, 246–252.
10.1097/SAP.0b013e31825b3d3a
CAS PubMed Web of Science® Google Scholar
Benito-Ruiz, J., Yoon, T., Guisantes-Pintos, E., Monner, J., & Serra-Renom, J. M. (2004). Reconstruction of soft-tissue defects of the heel with local fasciocutaneous flaps. Annals of Plastic Surgery, 52, 380–384.
10.1097/01.sap.0000105520.24063.bb
CAS PubMed Web of Science® Google Scholar
Chanda, A. (2018). Biomechanical modeling of human skin tissue surrogates. Biomimetics (Basel Switz), 23(3), 18.
10.3390/biomimetics3030018
Web of Science® Google Scholar
Chang, N.-J., Waughlock, N., Kao, D., Lin, C.-H., Lin, C.-H., & Hsu, C.-C. (2011). Efficient design of split anterolateral thigh flap in extremity reconstruction. Plastic and Reconstructive Surgery, 128, 1242–1249.
10.1097/PRS.0b013e318230c868
CAS PubMed Web of Science® Google Scholar
Elgohary, H., Nawar, A. M., Zidan, A., Shoulah, A. A., & Younes, M. T. (2019). Functional and aesthetic outcomes of reconstruction of soft-tissue defects of the heel with free flap. JPRAS Open, 19, 35–44.
10.1016/j.jpra.2018.10.008
PubMed Google Scholar
Fox, C. M., Beem, H. M., Wiper, J., Rozen, W. M., Wagels, M., & Leong, J. C. (2015). Muscle versus fasciocutaneous free flaps in heel reconstruction: Systematic review and meta-analysis. Journal of Reconstructive Microsurgery, 31, 59–66.
10.1055/s-0034-1384674
PubMed Web of Science® Google Scholar
Hidalgo, D. A., & Shaw, W. W. (1986). Reconstruction of foot injuries. Clinics in Plastic Surgery, 13, 663–680.
10.1016/S0094-1298(20)31546-7
CAS PubMed Web of Science® Google Scholar
Hong, J. P., & Kim, E. K. (2007). Sole reconstruction using anterolateral thigh perforator free flaps. Plastic and Reconstructive Surgery, 119, 186–193.
10.1097/01.prs.0000244856.98170.9c
CAS PubMed Web of Science® Google Scholar
Hu, R., Ren, Y.-J., Yan, L., Xiao, Z. H., Ding, F., Li, F., Han, Q., Cheng, W. J., & Kan, W. S. (2015). A free anterolateral thigh flap and iliotibial band for reconstruction of soft tissue defects at children's feet and ankles. Injury, 46, 2019–2023.
10.1016/j.injury.2015.06.046
PubMed Web of Science® Google Scholar
Kaikkonen, A., Kannus, P., & Järvinen, M. (1994). A performance test protocol and scoring scale for the evaluation of ankle injuries. The American Journal of Sports Medicine, 22, 462–469.
10.1177/036354659402200405
CAS PubMed Web of Science® Google Scholar
Kim, S. W., Hong, J. P., Chung, Y. K., & Tark, K. C. (2001). Sensate sole-to-sole reconstruction using the combined medial plantar and medialis pedis free flap. Annals of Plastic Surgery, 47, 461–464.
10.1097/00000637-200110000-00020
CAS PubMed Web of Science® Google Scholar
Kim, S. W., Kim, K. N., Hong, J. P., Park, S. W., Park, C. R., & Yoon, C. S. (2015). Use of the chimeric anterolateral thigh free flap in lower extremity reconstruction. Microsurgery, 35, 634–639.
10.1002/micr.22494
PubMed Web of Science® Google Scholar
Kitaoka, B., Harold, B., Alexander, I. J., Adelaar, R. S., Nunley, J. A., Myerson, M. S., & Sanders, M. (1994). Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot & Ankle International, 18, 349–353.
10.1177/107110079401500701
Web of Science® Google Scholar
Li, Q., Xiao, H., & Cen, Y. (2018). Application of selectively thinning of free anterolateral thigh flap in repair of heel skin and soft tissue defect. Zhongguo Xiu Fu Chong Jian Wai Ke za Zhi = Zhongguo Xiufu Chongjian Waike Zazhi = Chinese Journal of Reparative and Reconstructive Surgery, 32, 350–353.
PubMed Google Scholar
Mann, G., Nyska, M., Hetsroni, I., & Karlsson, J. (2006). Scoring systems for evaluating ankle function. Foot and Ankle Clinics, 11, 509–519.
10.1016/j.fcl.2006.05.001
PubMed Google Scholar
May, J. W., Gallico, G. G., Jupiter, J., & Savage, R. C. (1984). Free latissimus dorsi muscle flap with skin graft for treatment of traumatic chronic bony wounds. Plastic and Reconstructive Surgery, 73, 641–651.
10.1097/00006534-198404000-00022
PubMed Web of Science® Google Scholar
May, J. W., Halls, M. J., & Simon, S. R. (1985). Free microvascular muscle flaps with skin graft reconstruction of extensive defects of the foot: A clinical and gait analysis study. Plastic and Reconstructive Surgery, 75, 627–641.
10.1097/00006534-198505000-00001
PubMed Web of Science® Google Scholar
Oh, S. J., Moon, M., Cha, J., Koh, S. H., & Chung, C. H. (2011). Weight-bearing plantar reconstruction using versatile medial plantar sensate flap. Journal of Plastic, Reconstructive & Aesthetic Surgery, 64, 248–254.
10.1016/j.bjps.2010.04.013
PubMed Web of Science® Google Scholar
Ohjimi, H., Taniguchi, Y., Kawano, K., Kinoshita, K., & Manabe, T. (2000). A comparison of thinning and conventional free-flap transfers to the lower extremity. Plastic and Reconstructive Surgery, 105, 558–566.
10.1097/00006534-200002000-00013
CAS PubMed Web of Science® Google Scholar
Roos, E. M., Brandsson, S., & Karlsson, J. (2001). Validation of the foot and ankle outcome score for ankle ligament reconstruction. Foot & Ankle International, 22, 788–794.
10.1177/107110070102201004
CAS PubMed Web of Science® Google Scholar
Sanders, R., Fortin, P., DiPasquale, T., & Walling, A. (1993). Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clinical Orthopaedics and Related Research, 290, 87–95.
10.1097/00003086-199305000-00012
PubMed Web of Science® Google Scholar
Sharaf, B., Levine, J. P., Hirsch, D. L., Bastidas, J. A., Schiff, B. A., & Garfein, E. S. (2010). Importance of computer-aided design and manufacturing technology in the multidisciplinary approach to head and neck reconstruction. The Journal of Craniofacial Surgery, 21, 1277–1280.
10.1097/SCS.0b013e3181e1b5d8
PubMed Web of Science® Google Scholar
Song, Y. G., Chen, G. Z., & Song, Y. L. (1984). The free thigh flap: A new free flap concept based on the septocutaneous artery. British Journal of Plastic Surgery, 37, 149–159.
10.1016/0007-1226(84)90002-X
CAS PubMed Web of Science® Google Scholar
Sönmez, A., Bayramiçli, M., Sönmez, B., & Numanoğlu, A. (2003). Reconstruction of the weight-bearing surface of the foot with nonneurosensory free flaps. Plastic and Reconstructive Surgery, 111, 2230–2236.
10.1097/01.PRS.0000062564.35426.07
PubMed Web of Science® Google Scholar
Stecco, C., Corradin, M., Macchi, V., Morra, A., Porzionato, A., Biz, C., & de Caro, R. (2013). Plantar fascia anatomy and its relationship with Achilles tendon and paratenon. Journal of Anatomy, 223, 665–676.
10.1111/joa.12111
CAS PubMed Web of Science® Google Scholar
Struckmann, V., Hirche, C., Struckmann, F., Kolios, L., Lehnhardt, M., Kneser, U., & Daigeler, A. (2014). Free and pedicled flaps for reconstruction of the weightbearing sole of the foot: A comparative analysis of functional results. The Journal of Foot and Ankle Surgery, 53, 727–734.
10.1053/j.jfas.2014.06.009
PubMed Web of Science® Google Scholar
Zhang, Y.-Z., Li, Y.-B., Tang, M.-L., Xie, L., Geddes, C. R., Zhong, S. Z., & Pei, G. X. (2007). Application of three-dimensional digitalized reconstruction of an anterolateral thigh flap and an arterial dorsalis pedis flap. Microsurgery, 27, 553–559.
10.1002/micr.20410
CAS PubMed Web of Science® Google Scholar

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Volume42, Issue5

July 2022

Pages 460-469

Virtual planning of the anterolateral thigh free flap for heel reconstruction

Abstract

Purpose

Patients and methods

Results

Conclusions

CONFLICT OF INTEREST

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

Citing Literature

References

Information

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Virtual planning of the anterolateral thigh free flap for heel reconstruction

Abstract

Purpose

Patients and methods

Results

Conclusions

CONFLICT OF INTEREST

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

Citing Literature

References

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