Thin Free Perforator Flap as a Viable Option for Forefoot Reconstruction: Comprehensive Evaluation of Outcomes

Background: Reconstruction of forefoot defects often necessitates free tissue transfer due to the limited availability of local tissue. Microsurgical reconstruction of the forefoot remains challenging, as it requires durable yet thin soft-tissue coverage for functional restoration. This study aimed to evaluate the efficacy of free thin perforator flaps for forefoot reconstruction, with a focus on functional outcomes. Methods: Records of patients who underwent microsurgical forefoot reconstruction between March of 2020 and September of 2023 were reviewed. Development of postoperative complications and functional outcomes were evaluated. Results: In total, 53 patients (mean age, 62.7 years) were analyzed. The most common cause of defects was oncologic surgery, followed by chronic wound, with a majority involving the plantar side. The superthin anterolateral thigh flap and superficial circumflex iliac artery perforator flap were predominantly used. The median flap thickness was 4.0 mm. Digital vessels were the most frequently used as recipients. All but one flap survived, resulting in a success rate of 98.1%. Postoperative flap site complications developed in 20 patients, the majority of which resolved with conservative treatment. The median hospital stay was 8.0 days, and the mean time for initiating weight-bearing ambulation was 12.4 days. In the postoperative Foot Function Index questionnaire survey, the overall score was 9.41, showing minimal impairment, and it did not differ according to defect size or location. A secondary debulking operation was needed in 7 patients. Conclusion: Use of thin free perforator flaps might provide reliable outcomes with rapid recovery and excellent postoperative function in forefoot reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.