Reconstruction of the Lower Extremity Using Free Flaps
A 17-year-old man presented necrosis of the right first and second toes after sustaining a crushing injury in a traffic accident. In addition, the patient also had a 7 cm × 11.5 cm soft tissue defect on the plantar forefoot. The necrotized first and second toes were amputated from the metatarsophalangeal joint. The recipient sites were prepared by debridement. The plantar forefoot comes into contact with the floor during walking. We therefore elevated the medial plantar sensory free flap on the contralateral side of the plantar region for the reconstruction procedure. The medial plantar artery distributed in the flap was anastomosed to the dorsal pedis artery of the recipient site. In addition, two venae comitantes were anastomosed end-to-end to the great saphenous vein and the vena comitante of the dorsalis pedis artery. The medial plantar nerve innervating the flap was anastomosed to the deep peroneal nerve of the recipient site. A fullthickness skin graft was performed at the donor sites ().