Reconstruction of soft-tissue lesions of the foot with the use of the medial plantar flap

Abstract

ObjectiveTo study use of the medial plantar flap for reconstruction of the heel and foot.MethodThe authors share their clinical experience with the use of the medial plantar artery flap for coverage of tissue defects around the foot and heel after trauma. Twelve cases of medial plantar artery flap performed from January 2001 to December 2013 were included.ResultsOf the 12 patients, ten were male and two were female. The indications were traumatic loss of the heel pad in ten cases and the dorsal foot in two cases. All the flaps healed uneventfully without major complications, except one case with partial flap loss. The donor site was covered with a split-thickness skin graft. The flaps had slightly inferior protective sensation compared with the normal side.ConclusionFrom these results, the authors suggest that the medial plantar artery flap is a good addition to the existing armamentarium for coverage of the foot and heel. It is versatile flap that can cover defects on the heel, over the Achilles tendon and plantar surface, as well as the dorsal foot. It provides tissue to the plantar skin with a similar texture and intact protective sensation.

Reconstruction of Calcaneous Region after Melanoma Excision with Extended Medial Plantar Flap: Case Report

“…With this, the patient's morbidity is reduced by avoiding the removal of skin from other areas. Because it is a flap innervated by the cutaneous branch of the medial plantar nerve that attributes sensitivity, it is important for patient ambulation [9]. Sensitivity gradually returns to normal about one year postoperatively [10].…”

“…The most frequent surgical complications are partial loss of the graft and partial loss of the flap, both with a rate of 6 to 8%. The development of the surgical technique and postoperative care significantly reduce the prevalence of some complications [6,9].…”

“…In addition to the medial plantar flap, the reverse sural flap is also a good option for reconstruction in these cases [9]. Rashid et al compared the two flaps and concluded that the medial plantar flap presented fewer complications and resulted in an earlier return to activities than the reverse sural flap [8].…”

“…Rashid et al compared the two flaps and concluded that the medial plantar flap presented fewer complications and resulted in an earlier return to activities than the reverse sural flap [8]. Another option would be microsurgical flaps, but these may require more surgical time than the locoregional flaps and require a specialized team to perform them [9]. Regardless of the flap option chosen in the reconstruction of limbs, its indication should be as early as possible, because the importance is in the mobility of the affected limb joints and the return of the patient to his activities [9].…”

“…The medial plantar flap was initially described by Harrison and Morgan in 1981. It consists of a fasciocutaneous flap based on the medial plantar artery using the skin of the plantar cavus area (non-body-bearing area), an ideal tissue for reconstruction of the calcaneus area [6,[8][9]. The author presents a case of calcaneal region reconstruction with medial plantar flap, showing the possibility of extension of the flap including the lateral plantar artery, besides being able to remove the graft from the flap itself to avoid an increase of morbidity in other areas.…”