Reconstruction of a Distal Foot Skin Defect Using an Intermediate Dorsal Neurocutaneous Flap

Objective To present the use of an intermediate dorsal neurocutaneous flap for the reconstruction of defects on the distal foot. Methods From September 2016 to October 2018, five patients (mean age at operation 33.8 years; range, 7-70 years; female/male = 2/3) with skin defects on one of their feet caused by road-traffic accidents, electrical injury, and syndactyly correction were retrospectively reviewed. The size of the defects ranged from 2.0 cm x 1.0 cm to 5.0 cm x 3.5 cm. All patients had undergone a reconstruction surgery using intermediate dorsal neurocutaneous flap. One patient underwent a syndactyly correction, and four patients first experienced aggressive debridement. The sizes of the flaps were between 5.0 cm x 2.0 cm and 6.0 cm x 4.0 cm. The function, appearance, and pain of the injured foot were assessed using the Chinese Manchester Foot Pain and Disability Index and visual analogue scale. Results These five patients were systematically followed up for a mean of 15.8 months (range, 12-20 months). The donor sites were closed primarily in two cases, and skin grafts were performed in three cases. All the flaps survived with a success rate of 100%; the wounds healed well, and the color matches were excellent. Partial superficial flap necrosis occurred in one of five flaps, which was treated by dressing change using a hypertonic saline gauze. No significant problems were found at the donor site in any patient immediately afterwards or at follow-up. There were no problems in any patients associated with wearing shoes. Based on the Chinese Manchester Foot Pain and Disability Index, four patients were strongly satisfied and one was satisfied with the recovery of physical function; all the patients were strongly satisfied with the appearance of the injured foot; all five patients had an excellent score of pain intensity subscale. Except for one patient who reported mild pain, all the other patients reported no pain based on the visual analogue scale. Two typical cases are presented in this paper. Conclusions The intermediate dorsal neurocutaneous flap is an alternative and effective technique that can reliably cover minor- to medium-sized defects on the distal foot, toes, and web spaces. This surgical method leads to satisfactory functional recovery with minimal donor site morbidity, and no major vessels need to be sacrificed. This procedure offers an advisable option for orthopaedic surgeons to treat defects on the distal foot.