Skip to main content

Advertisement

SpringerLink
Log in

Osteo-fasciocutaneous parascapular flap transfer for reconstruction of the first ray of the foot

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Severe bone and soft tissue defects of the first metatarsal bone after trauma, tumor resection or osteomyelitis are challenging to treat. Partial amputation of the foot may be the consequence. However, due to its significance for gait, salvage of the first ray should be considered, whenever possible. One option for bone and soft tissue reconstruction, therefore, might be an osteo-fasciocutaneous parascapular flap transfer.

Methods

Five patients with bone and soft tissue defects of the first ray of the foot but intact MTP joint were treated with osteo- fasciocutaneous parascapular flap transfer, two after tumor resection, and three after severe bone and soft tissue trauma. Patients were followed for 12–36 months clinically and radiologically.

Results

All flaps survived. One revision was necessary because of venous thrombosis, which was treated successfully by thrombectomy and patch plastic. All osteosyntheses united and the scapular bone transplant adapted nicely to the new loading conditions. All patients were content with the result and would agree to have the operation again. Two patients were able to stand tiptoe and go jogging, one patient still had limitations of ADLs due to the concomitant injuries.

Conclusion

The osteo- fasciocutaneous flap proved to be very versatile and safe for foot reconstruction due to its favorable vascular anatomy. In all patients (partial), amputation of the foot could be avoided.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Rammelt S, Biewener A, Grass R, Zwipp H (2005) Foot injuries in the polytraumatized patient. Unfallchirurg 108:858–865

    Article  PubMed  CAS  Google Scholar 

  2. Zwipp H, Dahlen C, Randt T, Gavlik JM (1997) Complex trauma of the foot. Orthopade 26:1046–1056

    PubMed  CAS  Google Scholar 

  3. Musharrafieh R, Osmani O, Saghieh S, El-Hassan B, Atiyeh B (1999) Microvascular composite tissue transfer for the management of type IIIB and IIIC fractures of the distal leg and compound foot fractures. J Reconstr Microsurg 15:501–507

    PubMed  CAS  Google Scholar 

  4. Wyble EJ, Yakuboff KP, Clark RG, Neale HW (1990) Use of free fasciocutaneous and muscle flaps for reconstruction of the foot. Ann Plast Surg 24:101–108

    Article  PubMed  CAS  Google Scholar 

  5. Ramseier LE, Jacob HA, Exner GU (2004) Foot function after ray resection for malignant tumors of the phalanges and metatarsals. Foot Ankle Int 25:53–8

    PubMed  CAS  Google Scholar 

  6. Wang X, Qiao Q, Burd A, Qi K (2005) Reconstruction of distal foot wounds with reverse first dorsal metatarsal artery flap. Burns 31:1025–1028

    Article  PubMed  Google Scholar 

  7. Kurokawa M, Muneuchi G, Hamagami H, Fujita H (1998) Reconstruction of four metatarsal bone and soft-tissue defects using a serratus anterior muscle rib osteomyocutaneous free flap. Plast Reconstr Surg 101:1616–1619

    Article  PubMed  CAS  Google Scholar 

  8. Yazar S, Lin CH, Wei FC (2004) One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg 114:1457–1466

    Article  PubMed  Google Scholar 

  9. Exner GU, Jacob HA, Middendorp J (1998) Reconstruction of the first and second metatarsals with free microvascular fibular bone graft after resection of a Ewing sarcoma. J Pediatr Orthop B 7:239–242

    PubMed  CAS  Google Scholar 

  10. Rajacic N, Ebrahim MK, Grgurinovic S, Starovic B (1993) Foot reconstruction using vascularised fibula. Br J Plast Surg 46:317–321

    Article  PubMed  CAS  Google Scholar 

  11. Maskill JD, Bohay DR, Anderson JG (2006) First ray injuries. Foot Ankle Clin 11:143–63, ix–x

    Article  PubMed  Google Scholar 

  12. Prantl L, Babilas P, Fesar D, Kinner B, Eisenmann-Klein M, Schreml S, Roll C, Pfister K (2008) The use of fasciocutaneous and osteocutaneous parascapular flap for lower limb reconstruction: a retrospective study of twenty patients. Br J Plast Surg (in press)

  13. Cerkes N, Erer M, Sirin F (1997) The combined scapular/parascapular flap for the treatment of extensive electrical burns of the upper extremity. Br J Plast Surg 50:501–506

    Article  PubMed  CAS  Google Scholar 

  14. Filloux JF, Jarde O, Delval Y, Vives P (1995) Amputation below the elbow made possible by emergency covering of the stump with a free parascapular flap. J Chir (Paris) 132:27–29

    CAS  Google Scholar 

  15. Kumar P, Chandra R, Bhatnagar SK, Bhagia SP (1991) Parascapular fasciocutaneous flap for covering an above-elbow amputation stump. Burns 17:425–426

    Article  PubMed  CAS  Google Scholar 

  16. Vergote T, Revol M, Martinaud C, Le Fourn B, Servant JM, Banzet P (1993) [Use of parascapular semi-free flap in the covering of substance loss of the lower third of the leg and foot. Apropos of 3 cases]. Ann Chir Plast Esthet 38:192–197

    PubMed  CAS  Google Scholar 

  17. Chen D, Jupiter JB, Lipton HA, Li SQ (1989) The parascapular flap for treatment of lower extremity disorders. Plast Reconstr Surg 84:108–116

    Article  PubMed  CAS  Google Scholar 

  18. Birgfeld CB, Low DW (2006) Total Face Reconstruction Using a Pre-expanded, Bilateral, Extended, Parascapular Free Flap. Ann Plast Surg 56:565–568

    Article  PubMed  CAS  Google Scholar 

  19. Chandrasekhar B, Lorant JA, Terz JJ (1990) Parascapular free flaps for head and neck reconstruction. Am J Surg 160:450–453

    Article  PubMed  CAS  Google Scholar 

  20. Rand RP, Lin EY, Wood DE (2001) Total esophageal reconstruction using a tubed parascapular free flap. Ann Thorac Surg 72:267–270

    Article  PubMed  CAS  Google Scholar 

  21. Roll C, Prantl L, Feser D, Nerlich M, Kinner B (2007) Functional donor-site morbidity following (osteo-) fasciocutaneous parascapular flap transfer. Ann Plast Surg 59:410–414

    Article  PubMed  CAS  Google Scholar 

  22. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353

    PubMed  CAS  Google Scholar 

  23. Ellert U, Bellach BM (1999) The SF-36 in the Federal Health Survey–description of a current normal sample. Gesundheitswesen 61(Spec No):S184–S190

    PubMed  Google Scholar 

  24. Radoschewski M, Bellach BM (1999) The SF-36 in the Federal Health Survey–possibilities and requirements for application at the population level. Gesundheitswesen 61(Spec No):S191–S199

    PubMed  Google Scholar 

  25. Wallace GF, Stapleton JJ (2005) Transmetatarsal amputations. Clin Podiatr Med Surg 22:365–384

    Article  PubMed  Google Scholar 

  26. Mendicino SS (1993) Giant cell tumor of the first metatarsal bone en bloc resection with autogenous middle fibular strut graft. J Foot Ankle Surg 32:405–410

    PubMed  CAS  Google Scholar 

  27. Stokes R, Whetzel TP, Stevenson TR (1994) Three-dimensional reconstruction of the below-knee amputation stump: use of the combined scapular/parascapular flap. Plast Reconstr Surg 94:732–736

    Article  PubMed  CAS  Google Scholar 

  28. Mutaf M, Sensoz O (1994) Use of a pedicled parascapular flap combined with latissimus dorsi muscle for coverage of the forearm and reconstruction of elbow flexion. Plast Reconstr Surg 93:868–871

    Article  PubMed  CAS  Google Scholar 

  29. Burns JT, Schlafly B (1986) Use of the parascapular flap in hand reconstruction. J Hand Surg [Am] 11:872–875

    CAS  Google Scholar 

  30. Nassif TM, Vidal L, Bovet JL, Baudet J (1982) The parascapular flap: a new cutaneous microsurgical free flap. Plast Reconstr Surg 69:591–600

    Article  PubMed  CAS  Google Scholar 

  31. Masaki F, Takehiro D, Ryuuichi M, Kumi M (2000) Late reconstruction of two total metacarpal bone defects using lengthening devices and a double-barrel osteocutaneous free parascapular flap. Plast Reconstr Surg 106:102–106

    Article  PubMed  CAS  Google Scholar 

  32. Musharafieh R, Osmani O, Musharafieh U, Saghieh S, Atiyeh B (1999) Efficacy of microsurgical free-tissue transfer in chronic osteomyelitis of the leg and foot: review of 22 cases. J Reconstr Microsurg 15:239–244

    PubMed  CAS  Google Scholar 

  33. Atiyeh BS, Hussein MM, Tayim AM, Zaatari AM, Fakih RR (1997) Early microvascular reconstruction of Gustilo type III-C lower extremity wound. Case report. Scand J Plast Reconstr Surg Hand Surg 31:351–355

    Article  PubMed  CAS  Google Scholar 

  34. Pho RW (1979) Free vascularised fibular transplant for replacement of the lower radius. J Bone Joint Surg Br 61-B:362–365

    PubMed  CAS  Google Scholar 

  35. Bodde EW, de Visser E, Duysens JE, Hartman EH (2003) Donor-site morbidity after free vascularized autogenous fibular transfer: subjective and quantitative analyses. Plast Reconstr Surg 111:2237–2242

    Article  PubMed  Google Scholar 

  36. Garrett A, Ducic Y, Athre RS, Motley T, Carpenter B (2006) Evaluation of fibula free flap donor site morbidity. Am J Otolaryngol 27:29–32

    Article  PubMed  Google Scholar 

  37. Hartman EH, Spauwen PH, Jansen JA (2002) Donor-site complications in vascularized bone flap surgery. J Invest Surg 15:185–197

    Article  PubMed  Google Scholar 

  38. Klein S, Hage JJ, Woerdeman LA (2005) Donor-site necrosis following fibula free-flap transplantation: a report of three cases. Microsurgery 25:538–542; discussion 542

    Article  PubMed  Google Scholar 

  39. Peek A, Giessler GA (2006) Functional total and subtotal heel reconstruction with free composite osteofasciocutaneous groin flaps of the deep circumflex iliac vessels. Ann Plast Surg 56:628–634

    Article  PubMed  CAS  Google Scholar 

  40. Tvrdek M, Nejedly A, Kletensky J, Kufa R (1999) Treatment of chronic osteomyelitis of the lower extremity using free flap transfer. Acta Chir Plast 41:46–49

    PubMed  CAS  Google Scholar 

  41. Eisenschenk A, Kern O, Lehnert M, Weber U (1994) Free vascularized muscle flap transplantation in the treatment of chronic osteomyelitis. Chir Organi Mov 79:139–146

    PubMed  CAS  Google Scholar 

  42. Hanel DP (1989) Vascularized tissue transfer. An adjunct to the treatment of osteomyelitis. Orthop Rev 18:595–608

    PubMed  CAS  Google Scholar 

  43. Rhomberg M, Frischhut B, Ninkovic M, Schwabegger AH, Ninkovic M (2003) A single-stage operation in the treatment of chronic osteomyelitis of the lower extremity including reconstruction with free vascularized iliac bone graft and free-tissue transfer. Plast Reconstr Surg 111:2353–2361; discussion 2362–2363

    Article  PubMed  Google Scholar 

  44. Wei FC, Celik N, Yang WG, Chen IH, Chang YM, Chen HC (2003) Complications after reconstruction by plate and soft-tissue free flap in composite mandibular defects and secondary salvage reconstruction with osteocutaneous flap. Plast Reconstr Surg 112:37–42

    Article  PubMed  Google Scholar 

  45. Pearlstone DB, Janjan NA, Feig BW, Yasko AW, Hunt KK, Pollock RE, Lawyer A, Horton J, Pisters PW (1999) Re-resection with brachytherapy for locally recurrent soft tissue sarcoma arising in a previously radiated field. Cancer J Sci Am 5:26–33

    PubMed  CAS  Google Scholar 

  46. Ghaheri BA, Kim JH, Wax MK (2005) Second osteocutaneous fibular free flaps for head and neck defects. Laryngoscope 115:983–986

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma and Reconstructive Surgery, University of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany

    C. Roll, M. Nerlich & B. Kinner

  2. Division of Plastic Surgery, University of Regensburg Medical Center, Regensburg, Germany

    L. Prantl

Authors
  1. C. Roll
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Prantl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Nerlich
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Kinner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Kinner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roll, C., Prantl, L., Nerlich, M. et al. Osteo-fasciocutaneous parascapular flap transfer for reconstruction of the first ray of the foot. Arch Orthop Trauma Surg 128, 857–863 (2008). https://doi.org/10.1007/s00402-008-0592-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-008-0592-z

Keywords

Search

Navigation