Combined medialis pedis and medial plantar fasciocutaneous flaps for coverage of soft tissue defects of multiple adjacent fingers

Abstract

Soft tissue defects of adjacent multiple fingers covered by a single large flap require secondary separation of the flap into each finger. Such covering obstructs independent motion of injured fingers until the single large flap is separated. This report describes the technique of combined medialis pedis and medial plantar fasciocutaneous flaps for reconstructing soft tissue defects of multiple adjacent fingers. Three male patients (age range, 18-33 years) underwent soft tissue reconstructions of multiple adjacent fingers with combined flaps. Injuries involved three adjacent palmar fingers, two adjacent palmar fingers, and two adjacent dorsal fingers. Average sizes of the combined flaps were 4.2 × 4.0 cm for the medialis pedis flap and 3.0 × 1.8 cm for the medial plantar fasciocutaneous flap. All flaps survived without vascular complications, and donor sites healed uneventfully. All patients experienced excellent recovery of range of motion for the reconstructed fingers. In conclusion, combined flaps may offer an alternative for coverage of soft tissue defects that involve multiple adjacent fingers.

Anatomic basis and clinical application of the distally based medialis pedis flaps

“…Given the thinness of the soft tissue in this area, it is perhaps the optimal donor site for free flaps, especially when covering small-to medium-sized defects of the hand [18,25,39].…”

Sensate superficial inferior epigastric artery flap innervated by the iliohypogastric nerve for reconstruction of a finger soft tissue defect

“…Therefore, we decided to reconstruct with a flap. There are many other flaps for reconstruction of this case including local/distant flaps and free flaps such as medial plantar flap, medialis pedis flap, and venous flap, that we offered as reconstructive options before the treatment . Because the patient desired a concealable donor site with less morbidity, we decided to use a flap from the lower‐abdominal/inguinal region.…”

“…There are many other flaps for reconstruction of this case including local/distant flaps and free flaps such as medial plantar flap, medialis pedis flap, and venous flap, that we offered as reconstructive options before the treatment. [10][11][12] Because the patient desired a concealable donor site with less morbidity, we decided to use a flap from the lower-abdominal/inguinal region. SCIP flap and SIEA flap have a long pedicle suitable for various reconstructions, and their donor scars are well-concealable.…”

Medialis pedis flap for reconstruction of weight bearing heel

“…The medialis pedis flap uses a branch of the medial plantar artery as a vascular pedicle and is harvested from the medial side of navicula in the foot. Since its introduction by Masquelet and Romana (1990), the flap has been used to reconstruct defects of the finger pulp (Okada, Saito, Kazuki, & Nakamura, 2014;Rodriguez-Vegas, 2014). Okada et al (2014) reported on 3 cases in which combined medialis pedis and medial plantar fasciocutaneous flaps were elevated to cover soft tissue defects of adjacent fingers.…”

“…Since its introduction by Masquelet and Romana (1990), the flap has been used to reconstruct defects of the finger pulp (Okada, Saito, Kazuki, & Nakamura, 2014;Rodriguez-Vegas, 2014). Okada et al (2014) reported on 3 cases in which combined medialis pedis and medial plantar fasciocutaneous flaps were elevated to cover soft tissue defects of adjacent fingers. They described the combined flaps as a useful option for the coverage of soft tissue defects involving multiple adjacent fingers.…”