Clinical categorization and microsurgical reconstructive algorithm for complex tissue defects of the ankle and foot

The ankle and foot have a special anatomical structure and undertake crucial functions of body such as weight bearing, walking, running, and jumping. High-energy injuries often lead to complicated conditions and pose challenges to clinical tissue reconstruction. Complex tissue defects of the ankle and foot mostly present as multicompartmental defects involving skin and soft tissue, tendons, bones, and joints, as well as large-area skin and soft tissue defects. We divided the ankle and foot into nine regions based on the anatomical characteristics and physiological functions of different sites. Ten clinical types were then classified according to the involved regions of tissue defects and the presence of combined deep tissue defects. For each clinical type, appropriate flap donor sites and suitable special form of perforator flap procedures can be selected based on the requirements of microsurgical reconstruction, so as to achieve personalized and precise reconstruction and obtain optimal restoration of the appearance and function of the ankle and foot with minimal donor-site morbidities.