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Background <p>Traumatic midfoot and forefoot soft-tissue defects are difficult to reconstruct because local tissue is thin, deep structures are frequently exposed, and distal pedicled flaps may develop ischaemia or venous congestion. We evaluated the clinical outcomes of an anterolateral leg wide-pedicle dual-vascular flap based on the terminal perforator of the peroneal artery and the vascular plexus accompanying the superficial peroneal nerve.</p> Methods <p>We retrospectively reviewed 16 consecutive patients treated between September 2015 and June 2021. Data collected from operative and follow-up records included demographic and injury characteristics, exposed structures, associated osseous injury, defect and flap size, injury-to-coverage interval, operative time, flap-related events, infection, wound or graft dehiscence, donor-site healing, scar-related morbidity when documented, ankle range of motion, and American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score. Flap vascularity during follow-up was reassessed clinically rather than by routine vascular imaging. Results were summarized descriptively.</p> Results <p>The cohort comprised 12 men and 4 women, with a mean age of 37.9 years (range 22–53 years). Injury mechanisms were traffic accidents in 6 patients and crush injuries in 10. Three patients had isolated soft-tissue defects, whereas 13 had associated fractures, dislocations, or bone defects. Exposed tendon was present in 8 patients and exposed bone in 9. Defect size ranged from 4 × 5&#xa0;cm to 7 × 12&#xa0;cm and flap size from 5 × 7&#xa0;cm to 8 × 14&#xa0;cm. Mean operative time was 100.1&#xa0;min (range 75–130&#xa0;min). All 16 flaps survived. One patient developed early vascular compromise on postoperative day 2 that resolved after pedicle suture release and superficial decompression; no partial flap necrosis, total flap loss, infection, wound dehiscence, donor-site graft loss requiring regrafting, or clinically relevant scar contracture was documented. Mean follow-up was 14.9 months (range 6–24 months). Four patients had mild residual pedicle oedema. All donor sites healed after split-thickness skin grafting. Final ankle dorsiflexion ranged from 15 to 20 degrees and plantar flexion from 30 to 40 degrees. Mean AOFAS midfoot score was 83.1 (range 75–90). Standardized sensory testing, pain scores, footwear tolerance, and return-to-activity measures were not consistently available in the retrospective records.</p> Conclusions <p>In this small retrospective series, the anterolateral leg wide-pedicle dual-vascular flap provided reliable coverage for selected traumatic midfoot and forefoot defects without microvascular anastomosis. These findings should be interpreted as descriptive evidence rather than proof of superiority over established regional or free flaps. The proposed vascular mechanism and the sensory consequences of superficial peroneal nerve division require further dedicated evaluation.</p> Trial registration <p>Not applicable.</p>

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Anterolateral leg wide-pedicle dual-vascular flap for reconstruction of traumatic midfoot and forefoot soft-tissue defects: a retrospective case series

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月1日

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  • Xianqing Shi,
  • Yun Xue,
  • Lihong Liu,
  • Xiaowen Deng,
  • Wenshuai Li,
  • Wei Wang,
  • Jie Shi,
  • Peisheng Shi,
  • Yaqiang Zhang,
  • Guisheng Mou,
  • Wenbo Li,
  • Qiuming Gao

摘要

Background

Traumatic midfoot and forefoot soft-tissue defects are difficult to reconstruct because local tissue is thin, deep structures are frequently exposed, and distal pedicled flaps may develop ischaemia or venous congestion. We evaluated the clinical outcomes of an anterolateral leg wide-pedicle dual-vascular flap based on the terminal perforator of the peroneal artery and the vascular plexus accompanying the superficial peroneal nerve.

Methods

We retrospectively reviewed 16 consecutive patients treated between September 2015 and June 2021. Data collected from operative and follow-up records included demographic and injury characteristics, exposed structures, associated osseous injury, defect and flap size, injury-to-coverage interval, operative time, flap-related events, infection, wound or graft dehiscence, donor-site healing, scar-related morbidity when documented, ankle range of motion, and American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score. Flap vascularity during follow-up was reassessed clinically rather than by routine vascular imaging. Results were summarized descriptively.

Results

The cohort comprised 12 men and 4 women, with a mean age of 37.9 years (range 22–53 years). Injury mechanisms were traffic accidents in 6 patients and crush injuries in 10. Three patients had isolated soft-tissue defects, whereas 13 had associated fractures, dislocations, or bone defects. Exposed tendon was present in 8 patients and exposed bone in 9. Defect size ranged from 4 × 5 cm to 7 × 12 cm and flap size from 5 × 7 cm to 8 × 14 cm. Mean operative time was 100.1 min (range 75–130 min). All 16 flaps survived. One patient developed early vascular compromise on postoperative day 2 that resolved after pedicle suture release and superficial decompression; no partial flap necrosis, total flap loss, infection, wound dehiscence, donor-site graft loss requiring regrafting, or clinically relevant scar contracture was documented. Mean follow-up was 14.9 months (range 6–24 months). Four patients had mild residual pedicle oedema. All donor sites healed after split-thickness skin grafting. Final ankle dorsiflexion ranged from 15 to 20 degrees and plantar flexion from 30 to 40 degrees. Mean AOFAS midfoot score was 83.1 (range 75–90). Standardized sensory testing, pain scores, footwear tolerance, and return-to-activity measures were not consistently available in the retrospective records.

Conclusions

In this small retrospective series, the anterolateral leg wide-pedicle dual-vascular flap provided reliable coverage for selected traumatic midfoot and forefoot defects without microvascular anastomosis. These findings should be interpreted as descriptive evidence rather than proof of superiority over established regional or free flaps. The proposed vascular mechanism and the sensory consequences of superficial peroneal nerve division require further dedicated evaluation.

Trial registration

Not applicable.