Modified retrograde‐flow medial plantar island flap for reconstruction of distal dorsal forefoot defects—Two case reports

Abstract

Soft tissue reconstruction of the distal forefoot and toes poses a difficult problem. Skin grafts are not suitable when deep structures are exposed. Local flaps are not available, particularly for defects of the toes. Free flaps are spared for larger defects. Medial plantar flap has been widely used for plantar defects, especially weight-bearing surface of the heel. Distally based retrograde-flow design of this flap allows the transfer of the pedicled flap distally and provides coverage of soft tissue over the metatarsal heads. In this report, we further modified the retrograde-flow medial plantar island flap to extend its use for distal dorsal forefoot defects. The technique and outcomes of two patients are presented.

Traumatic Forefoot Reconstructions With Free Perforator Flaps

“…Limited reports have been published on the use of local flaps for forefoot coverage, such as the dorsal metatarsal V-Y advancement flap, reversed island flaps, reverse first dorsal metatarsal artery flap, distally based islanded dorsal flap, dorsal pedal neurocutaneous flap, retrograde-flow medial plantar island flap, reverse flow digital artery pedicle flap, and digital fillet flap (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). These flaps have the disadvantages of limited size and the requirement of a donor site, which is always impossible in traumatic foot injuries.…”

An Algorithm for Forefoot Reconstruction With the Innervated Free Medial Plantar Flap

“…Its use as a distally based island or rotation flap is supported in the literature. [28][29][30][31][32][33][34] However, an intact vascular pedicle imposes restrictions on flap mobilization and coverage of large distal wounds. It also depends on intact vascular collaterals linking the dorsal and plantar vascular channels that may have been injured in inciting trauma 35 or iatrogenically.…”

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

“…Anatomic studies concerning the vascular supply of the medial aspect of the foot were performed to provide plastic surgeons with a new alternative for forefoot reconstruction [14,29,38,48,49].…”