الفهرس 
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Abstract
The foot is one of the important parts of the body. It helps maintaining the standing posture, and during walking, it provides the body and the ground’s stable connection. This ability is affected by traumas through many pathological processes. The thin layer of subcutaneous tissue over the dorsum of the foot makes it easy to expose tendons and bones due to trauma, and flap coverage is mandatory. The microsurgery evolution has resulted in an abundance of reconstructive alternatives. Free flaps provide diversity for covering the foot’s varied sizes and defects.
This research compares the anterolateral thigh and medial sural artery perforator flaps regarding the function, complications, aesthetic outcomes, and patient satisfaction for reconstructing the foot dorsum’s soft tissue defects after traumas.
This research composed 40 patients with dorsum foot soft tissue traumatic defects attended to the Microsurgery Unit in Assuit University Hospitals and the Emergency Unit of the Plastic Surgery Department in Sohag University Hospitals from August 2017 to August 2018.
The patients were divided into two groups, group 1 where free anterolateral thigh perforator flap was used “free ALT flap group” which included 20 patients and group 2 where free medial sural artery perforator flap was used “free MSAP flap group” which included 20 patients.
Regarding the age incidence, it was noticed that age ranged between 4 to 54 years with mean 11.8±11.4 in group 1, while in group 2 it ranged between 3 to 42 years with mean 17.25±12.40. The defect size mean in group 1 was 155.05± 59.2 cm2, while in group 2, it was 102.6± 42.6 cm2. All flaps were completely survived in group 1, while in group 2, 17 flaps with one total flap loss and partial loss of two flaps.
Donner site closure in group 1 was 15 cases closed primary and five cases closed with split-thickness skin graft with the same result in group 2. The rate of secondary procedures was higher in group 1 in comparison with group 2. The rate in group 1 was 13 cases that needed secondary defatting, and the rate in group 2 was 2 cases that needed secondary procedures.
The follow-up period was between six months and one year and half postoperatively in both groups.
The free ALT perforator flap has many advantages: high success rate, less functional donner site morbidity, good color and texture matching, long and wide caliber vascular pedicle, less hospitalization time, less operation time. It was a good option in large defects coverage. The disadvantages of the ALT flap were the flap bulkiness which interfered with normal foot wear. The ALT flap was not the preferred technique for reconstructing the dorsal foot defects. It is thick, particularly in the obese, and requires either primary or secondary thinning, as well as many debulking stages. The donor site is hidden at women and children. Due to the large flap size and lengthy pedicle, the ALT flap is indicated for major dorsal foot defects.
The free MSAP flap has many advantages: thin, pliable, less hairy, good color and texture, long vascular pedicle, and less hospitalization time. It was a good option for small to medium-sized defects.
The medial sural artery perforator flap is an ideal technique for small and medium-sized defects in the dorsal foot. It is thin even in the obese, providing a good solution for the dorsal foot’s shallow defects. The MSAP flaps are aesthetically pleasing and enable proper fitting footwear, it is a good alternative flap for covering the dorsal foot defects, and had less liability for secondary procedures and debulking.