Plastic And Reconstruction Of Scar Of Ankle And Foot

Objectives:To summarize and compare the different surgical techniques for scar of ankle and foot, and to discuss the best surgical approaches for scar of different aspects of ankle and foot.Methods:138patients who consulted our department because of scar of ankle and foot from March1999to March2014were collected. They were composed of97cases who suffered from scar of anterior aspect of ankle and dorsum of foot,21cases who suffered from scar of posterior aspect of ankle and20cases who suffered from plantar scar. The patients received plastic surgery by skin grafts, local flaps, pedicle axial flap and free flap.98patients received plastic surgery by skin grafts (83cases suffered from scar of anterior aspect of ankle and dorsum of foot,11cases suffered from scar of posterior aspect of ankle and4cases suffered from plantar scar).9patients who suffered from scar of anterior aspect of ankle and dorsum of foot received plastic surgery by local flaps.15patients received pedicle flaps (3cases suffered from scar of anterior aspect of ankle and dorsum of foot,8cases suffered from scar of posterior aspect of ankle and4cases suffered from plantar scar).16patients received free flap reconstruction (2cases suffered from scar of anterior aspect of ankle and dorsum of foot,2cases suffered from scar of posterior aspect of ankle and12cases suffered from plantar scar). Area of the wound after tension-free, post-operative complications, duration of hospitalization, etc. were identified, and different reconstruction techniques were descriptive compared. Different surgical strategies are contrasted based on the age of patient and size of wound after tension-free treatment through two independent samples nonparametric tests.Results:98patients received plastic surgery by skin grafts, with the minimum reconstructive size of wound5cmx3cm, and the maximum size of wound15cmx10cm.6cases got skin loss,4of which received thin split skin graft,2of which healed after dressings. Partially epidermal necrolysis occurred in8cases, and partially necrosis of local flap occurred in2cases, which healed after dressings.9patients who suffered from scar of anterior aspect of ankle and dorsum of foot received plastic surgery by local flaps, partially necrosis of local flap occurred in1case, which healed after dressings.15patients received pedicle flaps, with the minimum reconstructive size of wound8cmx5cm, and the maximum reconstructive size of wound was14cmx10cm. Necrosis of flap occurred in1case, which healed by latissimus dorsi myocutaneous flap transplantation. Partially necrosis of flap occurred in1case which received thin split skin graft.16patients received free flap reconstruction, with the minimum reconstructive size of wound8cmx6cm, and the maximum reconstructive size of wound was22cmx10cm. Partially necrosis of flap in1case and infection of donor site in1case occurred which healed by thin split skin graft. All the patients got satisfactory reconstruction of the ability of standing balance and walking. There is no significant difference of patient’s age between the free flap group and pedicle axial flap group. Size of wound after tension-free treatment of the former group is larger than the latter one (P<0.05).Conclusions:The doctors should select appropriate plastic and reconstructive surgical techniques for scar of ankle and foot based on the scar location, scar area, scar depth, local skin and patient’s will. Skin grafts are still the most commonly used method of scar of anterior aspect of ankle and dorsum of foot and non weight-bearing area of sole. Flap transplantation should be selected in cases which deep tissue is exposed. Pedicle axial flap is the preferred choice, and free flap is applied when pedicle axial flap can not be utilized or to reconstruct large-area wound. Scar-achilles tendon flap is useful in patients for scar of posterior aspect of ankle and Achilles-tendon shortening when flap transplantation can not be used.