The role of microsurgical free flaps in foot and ankle surgery

Microsurgery is clearly an extremely useful adjunct in foot and ankle reconstruction. It requires careful planning between the microsurgeon and vascular, podiatric, and orthopedic surgeons. Ideally, each member of the team should have a special focus on limb salvage. The more experienced the microsurgeon and the better the planning the higher the chance of success. Current success rates in large microsurgical centers exceed 95% free flap survival. Skill in choosing the appropriate flap and optimizing how it is inset ensure an optimal aesthetic and functional result while minimizing the need for later revisions. Adding microsurgical free flaps to the armamentarium of limb salvage surgeons ensures a much higher salvage rate in limbs that heretofore posed too large of a reconstructive challenge and, therefore, were amputated. Current efforts should be directed toward the salvage of only those feet that will be functional, while avoiding limb salvage surgery in other cases. Microsurgical salvage should not be undertaken simply because it is technically feasible. The patient who undergoes 10 to 15 procedures over a 2 to 3 year interval and has a viable, but minimally functional, limb has not been helped. One, therefore, must be sure that the functional salvage can be performed within a defined number of operations in a given time. If not, a below-knee amputation should be considered strongly.