[Distally based saphenous neurocutaneous flap of lower rotating point repairing soft tissue defect in dorsum of forefoot].

OBJECTIVE: To investigate the surgical methods and clinical results of reconstructing soft tissue defects in dorsum of forefoot with distally based saphenous neurocutaneous flap of lower rotating point.

METHODS: From January 2005 to August 2007, 6 cases of soft tissue defects in dorsum of forefoot, including 4 males and 2 females aged 28-53 years, were treated with the distally based saphenous neurocutaneous flaps of lower rotating point. The soft tissue defect was in left foot in 2 cases and in right foot in 4 cases. Five cases of soft tissue defects were caused by crush, and 1 case was caused by traffic accident. Tendons and bones were exposed in all cases. The defects after debridement were 7.0 cm x 5.0 cm to 9.0 cm x 5.5 cm in size. Emergency operation was performed in 2 cases and selective operation in 4 cases. Rotating point of the flaps was from 1 to 3 cm above medial malleolus. The size of the flaps ranged from 8.0 cm x 6.0 cm to 13.0 cm x 6.5 cm. Neuroanastomosis was performed in 2 cases of the flaps. Skin defects in donor site were repaired with thickness skin graft.

RESULTS: Four cases of the transferred flaps survived completely and the other 2 cases began to swell and emerge water blister from the distant end of the flap after operation, which resulted in distal superficial necrosis of flaps, healing was achieved after change dressings and skin grafted. Skin graft in donor site survived completely in all cases. All cases were followed up from 6 to 18 months. The color and texture and thickness of the flaps were similar to recipient site. Pain sensation and warmth sensation of the 2 flaps whose cutaneous nerve were anastomosed recovered completely, two point discrimination were 8 mm and 9 mm respectively. Sensation and warmth sensation of the 4 flaps whose cutaneous nerve were not anastomosed recovered partly. All patients returned to their normal walking and running activities and no ulceration occurred. No donor site morbidity was encountered.

CONCLUSION: Blood supply of the distally based saphenous neurocutaneous flap of lower rotating point is sufficient, the flap is especially useful for repair of soft tissue defects in dorsum of forefoot.