Pfeifenberger Sarah, Hecker Andrzej, Watzinger Nikolaus, Moshammer Maximilian, Pignet Anna-Lisa, Draschl Alexander, Martin Ron, Louca Charalambos, Kamolz Lars-Peter, Spendel Stephan
Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria.
COREMED-Centre for Regenerative Medicine and Precision Medicine, Neue Stiftingtalstrasse 2, 8010 Graz, Austria.
Life (Basel). 2025 May 13;15(5):775. doi: 10.3390/life15050775.
Defects of the foot and ankle area pose a significant challenge for both patients and surgeons. While the primary objective of microvascular free flap reconstructions of lower leg defects is limb preservation, there should be an effort to obtain the best functional and aesthetic results possible and to restore the patient's quality of life. The aim of this study was to investigate the long-term post-operative functional outcome, health-related quality of life, scar quality, and aesthetic satisfaction in patients following microsurgical reconstructions of defects of the foot and ankle area.
We conducted a monocentric, controlled cohort study of adult patients who underwent microsurgical reconstructions for defects of the foot and ankle area between 2006 and August 2022 at our department. As a control, we recruited healthy individuals. Patient-Reported Outcome Measures questionnaires were used to assess long-term results regarding functionality (LEFS: Lower Extremity Functional Scale), health-related quality of life (SF-36: Short-Form 36 Health Survey Questionnaire), scar quality (PSAS: Patient Scar Assessment Scale), aesthetic satisfaction (Aesthetic Likert Scale), pain at rest and activity (10-point Numeric Rating Scale) and usage of footwear.
Of the 55 potential patients who had received microvascular free flaps for reconstructions of ankle and foot defects and were eligible for study inclusion, 13 (23.6%) agreed to participate in this study. The study cohort consisted of 84.6% male subjects and the mean follow-up period was 8.6 years (±5.2). Significant moderate limitations were observed with regard to physical function of the lower extremity (LEFS: 42.5 ± 20.5, = 0.002). Significant limitations were found in the SF-36 subscales of pain (55.8 ± 34.5, = 0.019), physical functioning (55.0 ± 29.7, = 0.013), and physical role functioning (38.5 ± 44.0, = 0.006). The study yielded favorable outcomes with regard to aesthetic satisfaction (14.3 ± 4.4) and scar quality (23.5 ± 13.5). Out of all the patients, 61% were required to wear orthopedic shoes or insoles.
Patients undergoing microsurgical reconstructions for ankle and foot defects experience moderate long-term physical limitations and persistent pain during activity. Furthermore, we observed a significant long-term impact on specific physical domains of health-related quality of life, whereas mental health seems less affected.
足踝部缺损对患者和外科医生而言都是重大挑战。虽然小腿缺损的游离微血管皮瓣重建的主要目标是保肢，但应努力获得尽可能最佳的功能和美学效果，并恢复患者的生活质量。本研究的目的是调查足踝部缺损显微外科重建术后患者的长期功能结局、健康相关生活质量、瘢痕质量和美学满意度。
我们对2006年至2022年8月期间在我科接受足踝部缺损显微外科重建的成年患者进行了一项单中心对照队列研究。作为对照，我们招募了健康个体。使用患者报告结局量表问卷来评估有关功能（LEFS：下肢功能量表）、健康相关生活质量（SF-36：简明健康调查3表问卷）、瘢痕质量（PSAS：患者瘢痕评估量表）、美学满意度（美学李克特量表）、静息和活动时疼痛（10分数字评定量表）以及鞋类使用情况的长期结果。
在55例接受游离微血管皮瓣重建踝部和足部缺损且符合研究纳入标准的潜在患者中，13例（23.6%）同意参与本研究。研究队列中男性受试者占84.6%，平均随访期为8.6年（±5.2）。观察到下肢身体功能存在显著的中度受限（LEFS：42.5±20.5，P = 0.002）。在SF-36量表的疼痛（55.8±34.5，P = 0.019）、身体功能（55.0±29.7，P = 0.013）和身体角色功能（38.5±44.0，P = 0.006）子量表中发现显著受限。在美学满意度（14.3±4.4）和瘢痕质量（23.5±13.5）方面，研究取得了良好结果。在所有患者中，61%需要穿戴矫形鞋或鞋垫。
接受踝部和足部缺损显微外科重建的患者经历中度的长期身体受限以及活动时的持续疼痛。此外，我们观察到对健康相关生活质量的特定身体领域有显著的长期影响，而心理健康似乎受影响较小。
