• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.147-153
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• 2000

Soft tissue defects of the dorsum of foot and ankle can be covered from skin graft to free tissue transfer. The extent of injury which may be complex including the exposure of paratenons or bones requires free flap reconstruction. Some of the precautions for reconstruction are providing minimal bulkiness and well conforming to irregular contour thus making normal footwear possible. Though the muscle flap having its advantages and versatility, the fascial flap such as temporoparietal fascial flap has been considered the choice for reconstruction of the dorsum of foot and ankle. The purpose of our study is to utilize the advantages and versatility of the muscle flap as a first choice for reconstruction for the defects involving the dorsum of foot and ankle. The gracilis muscle with its anatomic and donor characteristics, it can be utilized to maximal effect by expanding its slim muscle width removing the epimysium and reducing its bulk by muscle atrophy through denervation. We present our experience with ten cases of reconstruction for the dorsum of foot and ankle using the gracilis muscle free flap. Results were satisfactory without flap loss, skin loss and infection. The contour and aesthetic aspect of the foot was satisfactory. Gait analysis showed near normal gait without limitations from everyday activities. Normal footwear was tolerable in all the cases. The keys to consider in the reconstruction of the dorsum of foot and ankle are appropriate bulkiness, conforming to its contour and able to apply normal footwear. With minimal donor morbidity and satisfying results, the extended gracilis muscle should be considered as the first line for reconstruction of the ankle and dorsum of foot.

• Archives of Plastic Surgery
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• v.34 no.4
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• pp.441-447
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• 2007

Purpose: Various kinds of local flap or free flap have been used for coverage for soft tissue defects with bone exposure over the ankle and dorsum of foot. Adipofascial flaps, nourished by vascular plexuses of the subcutaneous tissue and deep fascia originating from the local perforators of the major vessels, appear particularly to be indicated for the reconstruction of these areas. Our experience with this flap on the dorsum of foot and ankle has also been quite encouraging. Methods: The design of the flap is determined by the size and the location of the defect. The base of the flap is chosen depending on the availability of the soft tissue around the defect. The ratio of the area of the flap to the area of the base wound be more reliable to predict the survival of the turnover flap by the conventional length-to-width ratio. Nineteen patients with defect over the dorsum of the foot and ankle were resurfaced with adipofascial turn-over flaps and skin graft. Results: The average age of the patients was 38.2 years(3 - 81 years). The flap size was from $2{\times}3cm$ to $8{\times}5cm$. The average follow-up time was 6 months. All flaps survived completely except one case who suffered distal necrosis of the flap. The additional skin graft was required for partial skin loss in the five cases. Other functional impairment was not noted. Conclusion: Dissection of the local adipofascial turnover flap is quite easy, quick, requires less time and sacrifice of surrounding muscle itself, and maintains major arteries. In most cases, donor-site morbidity is minimal with an acceptable scar, and both functional and esthetical results were satisfactory. Therefore, Adipofascial flap could be an option for the difficult wounds around the foot and ankle.

• Archives of Plastic Surgery
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• v.44 no.6
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• pp.545-549
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• 2017

When foot reconstruction is performed in the pretibial area, the ankle, or the dorsum of the foot, the need for a reliable flap remains a challenge. We found that the superficial inferior epigastric artery (SIEA) free flap can be used as an alternative tool for this purpose, as it helps to solve the problems associated with other flaps. We describe 2 cases in which we reconstructed the foot using an SIEA free flap, which was pliable enough to fit the contours of the area. Postoperatively, the flaps were intact and showed excellent aesthetic results. Thus, the SIEA free flap can be an alternative tool for patients with a low body mass index who undergo reconstructive surgery involving the pretibial area, ankle, knee, or dorsum of the foot, all of which require a soft and flexible flap.

• Journal of Oriental Medical Thermology
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• v.6 no.1
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• pp.23-31
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• 2008

Objective: The purpose of this study is to identify relationship between the PWV and the temperature difference. Methods: When it comes to senile patients who suffer from cold limbs, there is need to see whether or not the patient's low temperature of the limbs is do to arteriosclerosis. The Pulse Wave Velocity(PWV) is a non-invasive method measuring the artery's rigidness. And the Digital Infrared Thermal Imaging(D.I.T.I) is a non-invasive method to see the body's thermal change. Research on the interrelationship of the artery's rigidness and body's thermal distribution was done by using these two tests. The subjects of this research were patients between the age 40~65 who have done both the D.I.T.I and PWV in March 2005~ September 2005. They had to have no history of diabetes, coronary illnesses or cerebrovascular diseases which are diseases that can effect the outcome of the PVW, nor history of spondylopathy or dermatosis which can effect the outcome of the D.I.T.I. Results: The results were as follows. 1. There was a significant interrelationship between the right wrist-ankle PWV and the temperature difference of the right wrist-palm. 2. There was a significant interrelationship between the left wrist-ankle PWV and the temperature difference of the left wrist-palm. 3. There was no significant interrelationship between the right wrist-ankle PWV and the temperature difference of the right thigh-dorsum of foot. 4. There was no significant interrelationship between the left wrist-ankle PWV and the temperature difference of the left thigh-dorsum of foot. 5. The right ABI showed no significant interrelationship between the temperature difference of the right wrist-palm and the right thigh-dorsum of foot. 6. The left ABI showed no significant interrelationship between the temperature difference of the left wrist-palm and the left thigh-dorsum of foot. Conclusion: The study shows that there was a significant interrelationship between wrist-ankle PWV and the temperature difference of wrist-palm.

• Journal of Korean Foot and Ankle Society
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• v.7 no.1
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• pp.55-60
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• 2003

Purpose: To analyze the clinical results of excision of the symptomatic or recurred ganglion cysts of the foot and ankle. Materials and Methods: Twenty-one cases of the ganglions located in the foot and ankle area were followed for more than 12 months postoperatively. There were 9 males and 12 females, and the mean age was 42.3 years (range, 11-71 years). The mean duration of follow-up was 2.3 years (range, 1.1-4.1 years). Clinically previous treatment, size and location of the cyst, preoperative and postoperative AOFAS foot score, postoperative complication and satisfaction of patients were evaluated. Results: As a previous treatment, 7 patients received mean 1.3 bouts of aspirations, and 6 patients were recurred after mean 1.5 bouts of operations. The size of cyst ranged from 1.4 cm to 5.1 cm with the mean size of 2.7 cm. The cyst was most common in the dorsum of the foot and ankle, where 14 cases were found. Preoperative mean AOFAS foot. scores were low in the cysts associated with the tarsal tunnel syndrome, which was 71 points, and in the cyst of the plantar aspect of the 1st toe, which was 79 points. Postoperative mean AOFAS foot scores were significantly increased to 91 points and 92 points in preceding two groups. There were 2 cases (9.5%) of recurrence, both of which had satellite mass along the tendon sheath. Conclusion: Care should be taken in the diagnosis and treatment of ganglions in the tarsal tunnel and in the plantar aspect of the 1st toe. In case of ganglion cysts originated from the tendon sheath, consideration should be given for possible satellite mass.

• Archives of Reconstructive Microsurgery
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• v.12 no.1
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• pp.19-29
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• 2003

Soft tissue reconstruction of dorsum of the foot and ankle has long presented challenging problems for the reconstructive surgeon. Limitations of available local tissue, the need for specialized tissue, and donor site morbidity restrict the options. In an effort to solve these difficult problems, we have begun to use adipofascial flap based on the perforating branch of the peroneal artery. We present our early experience of 5 patients treated with this flap. Our patients ranged from 6 to 26 years in age and included 3 males and 2 females. The etiologies of the wounds were secondary to traffic accident, and crushing injury. The flaps had reverse flow in all patients. The flap and the adjoining raw area were covered with a full-thickness skin graft, while the donor site at the lateral aspect of the leg was closed primarily without grafting. The skin graft was taken from the inguinal area, which was closed primarily. Compared with other flap, this adipofascial flap is thinner, producing less bulkiness to the recipient site and minor aesthetic sequelae to the donor site. In our opinion, this flap is versatile, effective, and an addition to the armamentarium of the reconstructive surgeon for coverage of difficult wounds of the foot and ankle.

• Journal of Korean Foot and Ankle Society
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• v.8 no.2
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• pp.195-198
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• 2004

Purpose: To compare clinical characteristics of ganglions in hand & Foot. Materials and Methods: Seventeen cases of ganglions located in foot and fifty-five cases in hand. Excised from Mar.1988 to Apr.2003, were included in the study. The clinical characteristics and recurrence ratio were evaluated Results: The mean size of 2.2 cm in hand and 2.5 cm in foot. The most common area of ganglions are dorsum of foot and wrist. The cosmetic problem of palpable mass is the primary chief complaint of ganglions on hand and the pain is that of foot. The recurrence was found in 5 cases in hand and 4 cases in foot. The recurrence was related to incomplete excision of ganglion in foot and the large size of ganglion and incomplete excision of ganglion in hand. Conclusion: recurrence ratio in the cases of foot is higher than that of hand. The ganglions in foot and hand need to treated by meticulous surgical excision to prevent the recurrence.

• Journal of Korean Foot and Ankle Society
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• v.6 no.2
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• pp.242-246
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• 2002

A case of a peroneal nerve palsy caused by repeatedly recurred intraneural ganglion cyst is presented. A 19 year old male suffered from tingling sensation on the foot dorsum more than one year and underwent two times of mass excision and nerve palsy was recorvered. But it was recurred once more after 10 months after the second excision. The mass was located in the fibro-osseous tunnel against the fibular neck and the origin of the peroneus longus. The third complete excision was done and full recovery was obtained in 6 months.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.217-223
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• 2023

Purpose: Defects involving the ankle and foot are often the result of road traffic accidents. Many such defects are composite and require a flap for coverage, which is a significant challenge for reconstructive surgeons. Various locoregional options, such as reverse sural artery, reverse peroneal artery, peroneus brevis muscle, perforator-based, and fasciocutaneous flaps, have been used, but each flap type has limitations. In this study, we used the distally based lateral supramalleolar flap to reconstruct distal dorsal defects of the foot. The aim of this study was to analyze the efficacy of the flap in reconstructing distal dorsal defects of the foot. The specific objectives were to study the adequacy, reach, and utility of the lateral supramalleolar flap for distal defects of the dorsum of the foot; to observe various complications encountered with the flap; and to study the functional outcomes of reconstruction. Methods: The distal dorsal foot defects of 10 patients were reconstructed with distal lateral supramalleolar flaps over a period of 6 months at a tertiary care center, and the results were analyzed. Results: We were able to effectively cover distal foot defects in all 10 cases. Flap congestion was observed in two cases, and minor graft loss was seen in two cases. Conclusions: The distally based lateral supramalleolar flap is a good pedicled locoregional flap for the coverage of distal dorsal foot and ankle defects of moderate size, with relatively few complications and little morbidity. It can be used as a lifeboat or even substitute for a free flap.

• Journal of Korean Foot and Ankle Society
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• v.3 no.1
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• pp.49-52
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• 1999

Slight protrusion of the dorsum of midfoot without degenerative arthritis is common and usually can be treated by avoiding pressure of the shoe. Primary or posttraumatic degenerative arthritis accompanied by severe functional disability is treated by realignment and arthrodesis of the involved joints. We report a case of osteophytic changes in the form of lipping at the base of the first metatarsal and medial cuneiform which was treated by resection of the spurs. The cause of these spurs may be the congenital coalition of the first metatarsocuneiform joint.