Free Medial Plantar Flap Versus Free Dorsal Myocutaneous Flap for the Reconstruction of Traumatic Foot Sole Defects

Abstract

Background Trauma can cause large defects in the weight-bearing foot sole. The reconstruction of such defects poses a major challenge in providing a flap that is durable, sensate, and stable. The pedicled medial plantar flap has been commonly used for reconstructing heel and plantar forefoot defects; however, the ipsilateral instep region is usually compromised by trauma. The purpose of this article was to report the use of contralateral free medial plantar flaps for the coverage of weight-bearing plantar defects and to compare these with distant free flaps. Methods Between 2005 and 2019, 15 patients (10 men and 5 women) with weight-bearing foot plantar defects were treated with a contralateral medial plantar flap, 11 (7 men and 4 women) with either a latissimus dorsi flap or a scapular flap. The average age was 18.07 ± 10.14 years (range, 4–34 years) and 26.55 ± 13.05 years (range, 13–56 years), respectively. Surgery was performed as a primary or secondary reconstruction after a trauma by the same surgical team. Results The mean size of defects was 9.73 ± 3.55 × 6.43 ± 2.8 cm in the contralateral free medial plantar flap group and 17.14 ± 6.84 × 11.41 ± 4.29 cm in the free dorsal flap group. All flaps survived in both groups. In the instep flap group, the appearance was satisfactory, the flap was durable, and tactile sensation was preserved in all patients, and none required a revision procedure. Two patients experienced delayed union of the donor-site grafted skin. In the dorsal flap group, 5 patients complained of a partial necrosis or delayed union at the recipient site, and 9 developed recurrent ulcerations over the weight-\bearing area. Five patients achieved only partial sensation in the flap. Conclusions The contralateral medial plantar flap provides superior appearance, duration, and sensation over distant muscle flaps, without recurrent ulcerations. However, dorsal myocutaneous flaps may be used as a substitute when the defects are beyond the maximum boundaries of the instep area or are combined with bone loss.

Comparison of distally based sural artery and supramalleolar flap for coverage of dorsum of foot and ankle defects; a cross-sectional study of 53 patients

“…Our results do not match with the findings of other authors . [ 20 , [29] , [30] , [31] , [32] ] Analyzing our results and comparison between both flaps, we found that lateral supramalleolar artery flap provides excellent coverage to the dorsum of the foot up to the metatarsophalangeal joint. The advantages of the flap are easy dissection, robust pliable skin, flexibility in rotation of flap, and allow excellent coverage of dorsal skin defects of ankle and feet up to toes contrary to the belief that it cannot cover the dorsum of foot [ 31 ].…”

“…This is a big difference between the previous studies and mine. There is tremendous literature support in favor of sural artery flap for coverage of lower leg, foot, ankle, and perimalleolar areas [ 20 , 23 , [29] , [30] , [31] , [32] ].…”

“…Choosing the flaps to treat the wounds of this region must follow the basic requirements: the flap should be large enough to cover the defect, less bulky to allow for reasonable contour, should contain sensory nerves for protective sensation [ 32 ] Unfortunately both these flaps are insensate flaps and relatively thick and hairy. Many patients do ask for hair follicle ablation and defatting as a sequel.…”

Free tensor fascia lata true‐perforator flap transfer for reconstruction of the calcaneal soft tissue defect complicated with osteomyelitis in a patient with alcohol‐induced Charcot foot: A case report and literature review

“…Superficial, non‐infected ulcers can be treated conservatively very well (Malhotra et al, 2012). Persistent or infected wounds require a multidisciplinary approach for wound care, incorporating serial debridement followed by definitive soft‐tissue reconstruction (Chou et al, 2018; Crowe et al, 2019; Deiler et al, 2000; Elgohary et al, 2018; Fox et al, 2015; Han et al, 2020; Khai Luen & Wan Sulaiman, 2017; Kim et al, 2016; Kimura et al, 2003; Koshima et al, 2001; Nahai et al, 1978; Park et al, 2017; Rainer et al, 2003; Santanelli et al, 2002; Song et al, 2016; Van Landuyt et al, 2005; Yamamoto, 2019; Yamamoto et al, 2016, 2019, 2020). In the current literature, further or exemplary soft‐tissue involvement is not addressed in the treatment regimens.…”

“…There are several articles reporting free flap reconstructions for heel soft tissue defects (Table 1) (Al Maksoud et al, 2016; Chou et al, 2018; Elgohary et al, 2018; El‐Shazly et al, 2008; Grauberger et al, 2020; Han et al, 2020; Kang et al, 2013; Khai Luen & Wan Sulaiman, 2017; Kim et al, 2016; Kuran et al, 2000; Liu et al, 2014; Oh et al, 2011; Park et al, 2017; Song et al, 2016; Van Landuyt et al, 2005; Yücel et al, 2000). Medial plantar and medialis pedis (MP) flap are ones of the most popular flaps for heel reconstruction, mainly as pedicled flaps.…”