Innervated free flaps for foot reconstruction: a review

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J Reconstr Microsurg. 2006 Aug;22(6):433-42.

Innervated free flaps for foot reconstruction: a review.

Ducic I, Hung V, Dellon AL.

Department of Plastic Surgery, town University, Washington, D.C.

Whether to provide a sensate plantar weight-bearing flap to

reconstruct the foot remains an unanswered, but frequently asked,

question. It has been more than a decade since Graham and Dellon

reviewed this subject. Increasing emphasis on outcome analysis of

microsurgical reconstruction has prompted this new review. All

published peer-reviewed literature related to reconstruction of the

plantar surface of the foot was reviewed to identify whether the

flaps were 1) local, regional or distant; 2) innervated or non-

innervated and, if innervated, then 3) identified as to the donor and

the recipient peripheral nerves.

Outcome measures included direct measurement of sensibility,

development of ulceration, and activities of daily living. It was

concluded that it is still not possible to determine that innervated

flap reconstruction of the weight-bearing portion of the foot is

critical for either durability or ambulation.

It is recommended that the original nerves that innervate the flap be

blocked prior to harvest to improve flap design, i.e., that the flap

actually contains the intended nerve. It is recommended that

appropriate donor nerves are selected to innervate the flaps, e.g.,

the calcaneal nerve should be used to reinnervate heel

reconstructions (rather than the sural nerve), and medial/lateral

plantar branches be used to reinnervate the arch and the forefoot.

Reinnervating a muscle flap with a sensory nerve will permit

reinnervation of the muscle and the overlying skin, but whether this

provides a superior result in durability and gait remains to be seen.