Dynamic loading performance of fasciocutaneous flaps and implications for gait.

摘要

BACKGROUND: Recent advancements in microsurgery allow the free tissue transfer for reconstruction of soft-tissue defects on the plantar surface of the foot. Fasciocutaneous flaps are one available option to the reconstructive surgeon. However, their functional weight-bearing capabilities have never been adequately evaluated. This study investigated the dynamic loading performance of selected fasciocutaneous flaps during walking using instrumented gait analysis. METHODS: We investigated 6 feet with reconstructed heels along with their contralateral normal feet. A control group of normals was included also. Time-distance, ground reaction force parameters and plantar foot pressure distribution were evaluated. Data were normalized to account for anthropometric variations. A series of t-tests were used to investigate contrasts. FINDINGS: Walking velocity of injured subjects was decreased (P<0.0001). Step length and single limb support were the shortest for the involved feet (P<0.04). Double limb support andswing were the longest (P<0.0002). The reconstructed heels sustained high pressures (P<0.05) and vertical loadings underlining their functional weight-bearing capabilities. However, the walking patterns implemented by the injured subjects resulted in reduced anterior-posterior shear forces that could help maintain the integrity of the shear plane at the graft-recipient bed interface. INTERPRETATION: The dynamic loading capabilities of the fasciocutaneous flaps make it an effective means for restoring functional gait. Patients implement gait patterns that result in primarily decreasing shear forces. Consequently, the fasciocutaneous flaps should be included in the surgeons' armentarium as a plausible reconstructive means for soft-tissue defects on the plantar surface of the foot.