Free Medial Plantar Perforator Flaps for the Resurfacing of Finger and Foot Defects

Abstract

In this article, three cases in which free medial plantar perforator flaps were successfully transferred for coverage of soft-tissue defects in the fingers and foot are described. This perforator flap has no fascial component and is nourished only by perforators of the medial plantar vessel and a cutaneous vein or with a small segment of the medial plantar vessel. The advantages of this flap are minimal donor-site morbidity, minimal damage to both the posterior tibial and medial plantar systems, no need for deep dissection, the ability to thin the flap by primary removal of excess fatty tissue, the use of a large cutaneous vein as a venous drainage system, a good color and texture match for finger pulp repair, short time for flap elevation, possible application as a flow-through flap, and a concealed donor scar.

Free medial plantar artery perforator flap for finger pulp reconstruction: Report of a series of 10 cases

“…Although Koshima et al reported the successful use of free medial plantar artery perforator flaps for reconstructing finger and foot defects without transecting the medial plantar or posterior tibial system, subsequent reports have been sparse. 15 The Medialis pedis flap was first described by Masquelet and Romana 25 and was later used as a free flap by Ishikura et al 7 This flap has been used to reconstruct defect of the volar side of finger. 26,27 Compared with the MPAP flap, which also provides a glabrous skin surface, the medialis pedis flap is thinner and may not always provide an adequate cushioning surface.…”

“…Thus, given the unique characteristics of the finger pulp, the medial plantar area is the preferred donor site. Although the free MPAP technique has been reported and presented in the related literature, [14][15][16] no serial study has examined the use of this flap in finger pulp reconstruction. The purpose of this report is to present the our results with using the medial plantar artery perforator flap for reconstruction of composite finger pulp defects and restoration of fingertip sensation after traumatic injury.…”

Anatomical basis and design of the distally based lateral dorsal cutaneous neuro-lateral plantar venofasciocutaneous flap pedicled with the lateral plantar artery perforator of the fifth metatarsal bone: a cadaveric dissection

“…In 1995, Masquelet and Romana [12] and Ishikura et al [6] reported the successful use of the medialis pedis flap based on a branch from the medial plantar artery for the reconstruction of foot soft-tissue defects. In 2001, Koshima [9] reported a free medial plantar artery perforator flap that was exclusively based on the medial plantar artery perforator only. This flap can be an island flap for heel coverage and forefoot plantar weight-bearing defects without transecting the medial plantar or posterior tibial systems.…”

Donor site morbidity of the medial plantar artery flap studied with gait and pressure analysis

“…the MPA flap can be raised with the medial plantar nerve to provide sensation. The MPA flap is best suited to resurface glabrous defects of the sole of the foot and the heel, both as pedicled and free flaps [3], and glabrous defects of the pulp of the digits of the hand [5,11,12]. It is clear from these subjects that the primary aim of providing stable sensate skin was achieved in these difficult cases.…”

“…The medial plantar artery flap's vascular anatomy has been studied in detail by Shahanan et al in 1979 [2], and its use as a free flap described by Morrison et al in 1983 [3]. Since then it has been used to cover local wounds around the foot and medial ankle [4] and as a free flap to cover hand and finger defects [5].…”