Foot and ankle reconstruction is a battlefield of function and form. Every subunit has its own demands — the dorsum needs thin, pliable coverage; the heel demands durable, glabrous-like skin. In this landmark PRS 2010 paper, Hollenbeck et al. applied the subunit principle to 165 free flaps, giving surgeons a blueprint for tailored, long-term reconstruction success.
Summary:This episode breaks down the seven distinct subunits of the foot and ankle, each with unique reconstructive goals. We discuss the data behind flap outcomes, limb salvage (89% at 5 years), and complication rates, including the common pitfalls like flap debulking and late ulceration — especially in the heel subunit.
We’ll explore how subunit-based flap planning improves durability, shoe-fit, and overall limb function — plus, how specific flaps like the radial forearm, ALT, and latissimus dorsi perform across zones.
Key Takeaways:
7 subunits = 7 reconstructive goals.
Heel (Subunit 5) = highest instability risk.
Mean ambulation: 3.1 months.
Limb salvage: 89% at 5 years.
Subunit mapping improves both form and function.
Citation:
Hollenbeck ST, Woo S, Komatsu I, et al. Longitudinal Outcomes and Application of the Subunit Principle to 165 Foot and Ankle Free Tissue Transfers. Plast Reconstr Surg. 2010;125(3):924–934. DOI: 10.1097/PRS.0b013e3181cc9630
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