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Reconstruction of soft tissue defects of the sole is a challenging problem. Bulky
flaps interfering with footwear is common sequelae. Multiple operations are often
required to achieve a functional foot. We describe the case of a motorcyclist who
sustained degloving injury to his left sole when he was hit by a car. The defect was
resurfaced by a free latissimus dorsi flap and a meshed skin graft. After a year partial
flap thinning was done, as it was bulky. Though he was grateful for the reconstruction
he still could not wear a shoe, the gait was affected and he felt the flap was wobbly.
8 months later he underwent a further flap thinning. At this stage lack of adherence
of the flap to the undersurface was noted and a flap hitch
was done. 3 looped nylon sutures were used to lift up the internal portion of the
sole bearing part of the flap and suspended onto periosteum of the lateral malleolus,
navicular and posteromedial calcaneum (Figure 1). The flap hitch promotes adhesion and permanent uplift of the flap. This also produced
a good contouring of the flap. Though flap hitch has been described in various parts
of the body we do think this is worth considering in combination with flap thinning
especially for the wobbly sole flap.
