Functional lower limb salvage with an osteocutaneous filet flap of the foot.

An osteocutaneous foot filet flap based on the posterior tibial vessels was successfully used to provide tibial coverage in a patient requiring a below-knee amputation following a high-voltage electrical injury. Addition of the calcaneus to the standard foot filet flap provided a vascularized bone graft that served to both lengthen the tibia and secure the flap via a tibial-calcaneal synostosis. The synostosis provided firm anchoring of the flap and allowed for a partial end-bearing, below-knee prosthesis.

Distal foot coverage with a reverse dorsalis pedis flap.

A reverse dorsalis pedis flap based on the proximal communicating branch of the dorsalis pedis artery was successfully used to close distal forefoot defects in two patients. The skin paddle was oriented transversely across the ankle crease, allowing for direct closure of the flap donor site. Both patients maintained full active ankle motion without bowstringing of the dorsal foot tendons and did not require special footwear. Both flaps maintained sensation to light touch and pinprick. We believe that this flap offers a viable alternative when faced with the challenge of a small soft-tissue defect requiring flap reconstruction in the distal foot.