Background: Severe bone and soft tissue defects of the first metatarsal bone after trauma, tumor resection or osteomyelitis are challenging to treat. Partial amputation of the foot may be the consequence. However, due to its significance for gait, salvage of the first ray should be considered, whenever possible. One option for bone and soft tissue reconstruction, therefore, might be an osteo-fasciocutaneous parascapular flap transfer.
Methods: Five patients with bone and soft tissue defects of the first ray of the foot but intact MTP joint were treated with osteo- fasciocutaneous parascapular flap transfer, two after tumor resection, and three after severe bone and soft tissue trauma. Patients were followed for 12-36 months clinically and radiologically.
Results: All flaps survived. One revision was necessary because of venous thrombosis, which was treated successfully by thrombectomy and patch plastic. All osteosyntheses united and the scapular bone transplant adapted nicely to the new loading conditions. All patients were content with the result and would agree to have the operation again. Two patients were able to stand tiptoe and go jogging, one patient still had limitations of ADLs due to the concomitant injuries.
Conclusion: The osteo- fasciocutaneous flap proved to be very versatile and safe for foot reconstruction due to its favorable vascular anatomy. In all patients (partial), amputation of the foot could be avoided.