Regionalized coverage of the totally degloved foot by a combination of "Boat sock" style free flap and skin graft. Issue 6 (June 2022)

• Record Type: Journal Article
• Authors: Ou, Qifeng; Dou, Xiaolin; Wu, Panfeng; Zhou, Zhengbing; Pan, Ding; Tang, Ju-yu
• Is Part Of: Injury. Volume 53:Issue 6(2022)
• Page Start: 2333
• Page End: 2339
• Publication Date: 2022-06
• Subjects: Foot -- Degloving injury -- Flap -- Skin graft -- Regionalized coverage; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2022.02.015
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: This article proposes a regionalized coverage, which uses the large free skin flaps to cover the highly functional subunit (weight-bearing area and ankle-around area), and skin graft to cover less functional subunit (dorsum). It marks as the second article which combines the skin flap and skin graft to cover the degloved foot, and the first article to cover the totally degloved foot (planta and ankle). We reported cases of degloved foot with dead space, which was eliminated by muscle flap in chimeric ALTP flap. It indicates the necessity of flap-based coverage in complicated degloving injury, which further prove the advantage of our regionalized coverage. The regionalized reconstruction uses two flaps to formulate the ankle-like shape, which give a more extensive coverage on the highly functional area-the ankle, which is not attainable by single flap. We firstly notice the problem of "uneven thickening" in the reconstructed planta by two skin flaps. We recommend the use of homogeneous donor sites, like right and left thighs, or right and left thoracic dorsal regions, for flap harvest, to avoid this phenomenon. Abstract: Introduction: To maximize the morpho-functional recovery on the totally degloved foot while not excessively introducing the technical complexity of microsurgery, we present a regionalized reconstruction, in which the highly functional subunit (weight-bearing area and ankle-around area) is covered by free skin flaps, and the less functional subunit (dorsum) by skin graft. Methods: From June 2011 to December 2017, 10 patients who had total degloving injury on foot underwent reconstruction based on regionalized coverage. As the shape of combined flaps resemble a boat sock in high-heeled shoe, we name it as "Boat Sock" flaps. Complication like vascular compromise, partial or total flap loss, Equinus deformity and delayed plantar ulceration were documented elaborately. Secondary surgeries were also recorded. Foot function was evaluated by Maryland foot score at the last follow up. Results: Twenty-one free skin flaps were used for "Boat sock" coverage on highly functional subunits. Flap dimension ranged from 19×5cm 2 to 28×8cm 2 (mean 151cm 2 ). Among these flaps, one experienced partial necrosis which was treated conservatively, one experienced burn due to lack of protective sensation. Complication like Equinus deformity or delayed plantar ulceration did not occur. Secondary surgery included debulking on two cases. Mean Maryland foot score was 90.4. Conclusion: This regionalized coverage by "Boat Sock" flaps and skin graft could serve as a standard procedure for reconstruction of the totally degloved foot, by offering the benefits of multi-plane coverage, a well-contoured ankle, an abrasion-tolerant planta, and eclectic surgical complexities.