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fasciocutaneous flap, foot reconstruction, neuropathic foot ulcer, vertical profunda artery perforator flap, wound closure



  1. Alfonso, Allyson R. BS, BA
  2. Mayo, James L. MD
  3. Sharma, Vishal K. MD, FRCSC
  4. Allen, Robert J. Sr MD
  5. Chiu, Ernest S. MD, FACS


BACKGROUND: Plantar foot reconstruction requires special consideration of both form and function. There are several fasciocutaneous flap options, each with indications and reservations.


CASE STUDY: This case presents a new application of the vertical profunda artery perforator flap for definitive closure of a neuropathic foot ulcer in a young woman with spina bifida. The postoperative course was uneventful, and the flap survived completely. The surgical and donor sites were without wound recurrence at 5-month follow-up.


DISCUSSION: Understanding the variability of foot flap options is important because of unique cases such as the one presented where the wound was caused by specific and less commonly observed foot anatomy. The specific choice to use the vertical profunda artery perforator flap for this patient and her neuropathic wound type was made based on its excellent flexibility, durability, and donor site appeal.


CONCLUSIONS: The vertical profunda artery perforator flap has adequate surface area and bulk and a favorable pedicle length and caliber, can be thinned, and leaves a donor scar in a less conspicuous area than other popular free flaps for lower-extremity reconstruction. For these reasons, it should be considered a first-line therapy for free flap coverage of selected foot wounds.