Patient Descriptions and Management

Fourteen different flaps were used in 144 patients. Thirty patients were female, and 114 were male, with a 3.8:1 male-to-female ratio. There were 64 left-foot and 80 right-foot injuries. Comorbidities included hypertension, diabetes mellitus and osteomyelitis (Table 1). Trauma was the most common etiology, followed by skin ulcers and inflammation and then tumors (Table 1). Flap necrosis > 60% was regarded as complete necrosis (CN), and flap necrosis ≤ 60% was regarded as partial necrosis (PN) [21]. According to Godina’s study [22], the time window from trauma to 72 hours after the trauma was considered as the acute period, while the time window of the subacute stage was between 72 hours and 90 days after the trauma. In our series, 107 trauma patients underwent the flap transfer procedures in the subacute period (Table 2). In addition, preoperative wound bed inflammation and postoperative wound infection were identified by bacterial cultivation. Based on our clinical experience, the foot and ankle were divided into eight subunits within three regions (Fig 1).

K-wires, hollow screws and external fixators were used to repair fractures of the foot and ankle. Additionally, the injured tendons and major nerves were reconstructed, and negative pressure wound therapy was used. Thorough and complete debridement was carried out before the pedicled or free flap transfer. Postoperative flap care and monitoring were carried out 3–5 days after surgery, and low-molecular-weight heparin calcium was systemically administered for anticoagulation.