Medial Plantar Artery Perforator Flap: Experience with Soft-tissue Coverage of Heel

Abstract

Background:Soft-tissue coverage is a challenge to the ankle and foot reconstructive surgeon due to its unique requirement of simultaneously withstanding body weight and to provide sensory feedback. We share our experience of medial plantar artery perforator (MPAP) flap, which provides a robust sensate coverage to heel defects.Methods:Three-year retrospective study, which included soft-tissue injury to heel. All patients underwent MPAP flap for the coverage of the defect. Patients' demographic, mode of injury, defect size, flap size and survival, time to start weight bearing, return of protective sensations, and comparative 2-point discrimination with opposite heel were studied.Results:We studied 16 cases with heel soft-tissue injuries. Fifteen had motor vehicle accident, and 1 had chronic diabetic wound. Mean surface area of flap was 4 × 5 cm. Except 1 flap, 15 flaps had complete survival and provided reliable wound coverage with comparable normal sensation as on other foot.Conclusion:We suggest that MPAP flap, when available, is a good local tissue for heel wounds coverage.

The Use of Local Medial Plantar Artery Flap for Heel Reconstruction: A Systematic Review

“…All studies reported on the etiology of the heel defect. The maximum diameter in centimeters of the heel defects was reported in 10 out of the 18 studies, and not reported in eight studies [15,16,20,24,26,28,29,31]. The average follow-up or range of follow-up was reported in 14 studies but not mentioned in four studies [15,16,28,29].…”

“…One hundred thirty-five cases remained after removal of duplicates. The characteristics of includes studies [10,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], and the results of quality analysis of each study are illustrated in There was significant heterogenicity in the reported cases. Among 14 studies, the average age and/or range were reported or determined [10,[15][16][17]19,20,22,23,[25][26][27][29][30][31] but was absent in the remaining four studies [18,21,24,28].…”

“…All included studies reported on minor flap complications. Eleven studies reported on the loss of protective sensation of the MPA flap [10,[15][16][17][18]22,[25][26][27][28]31] while five studies went on further to report on the comparison of protective sensation of the reconstructed flap to the contralateral normal side [17,22,26,28,31]. Seventeen studies reported on donor site complications and 12 of them reported on the post flap reconstruction ambulatory status of the patient.…”

“…Five of the studies compared the protective sensation of the reconstructed flap to the contralateral normal side. Four (4) of the studies concluded that although protective sensation was present, it was inferior compared to the contralateral normal side [17,26,28,31] and one study concluded that the two groups were comparable [22]. For patients that were ambulatory prior to undergoing MPA flap reconstruction, they all remained fully ambulatory after the flap reconstruction.…”

“…In this review, only 1/148 patients lost protective sensation. Of the few studies that attempted to compare the reconstructed flap to the contralateral normal side, most concluded the presence of protective sensation although was inferior to the contralateral side [17,26,28,31]. This feature of the MPA makes it superior to skin grafts, local flaps, and other non-sensate flaps.…”