Reconstruction of Defects in the Weight-Bearing Plantar Area Using the Innervated Free Medial Plantar (Instep) Flap

Löfstrand, Jonas; Lin, Chih‐Hung

doi:10.1097/sap.0000000000001274

Cited by 31 publications

(15 citation statements)

References 25 publications

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“…Several free flaps have been used as sensate flaps with improved sensory recovery, such as radial forearm flaps (Baas, Duraku, Corten, & Mureau, 2015; Ma, Cheng, & Liu, 2011; Médard de Chardon, Balaguer, Chignon‐Sicard, et al, 2009), lateral arm flaps (Kalbermatten, Wettstein, von Kanel, et al, 2008), medial plantar flap (Hosseinian, Gharibi Loron, & Nemati, 2018; Löfstrand & Lin, 2018), and anterolateral thigh flaps (Luenam, Prugsawan, Kosiyatrakul, Chotanaphuti, & Sriya, 2016; Ribuffo, Cigna, Gargano, Spalvieri, & Scuderi, 2005; Rinkinen, Diamond, Lans, Cetrulo, & Eberlin, 2020). The PTAP flap has not been used as a sensory flap.…”

Section: Introductionmentioning

confidence: 99%

Free extended posterior tibial artery perforator flap with the neurovascular plexus of a saphenous nerve branch for large soft tissue and sensory reconstruction: Anatomic study and clinical application

et al. 2020

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Background The posterior tibial artery perforator (PTAP) flap is a useful tool for reconstruction of soft tissue defects in the leg. However, the size and reliability of the flap largely depends on the quality of the perforator by which the flap is supplied, and the sensory recovery of the flap is limited. In this study, the anatomy of the saphenous nerve branches and their accompanying vessels was investigated, and a free extended PTAP flap with the neurovascular plexus of a saphenous nerve branch was designed for large soft tissue and sensory reconstruction in a series of clinical cases. Methods Sixteen adult cadaveric legs perfused with red latex in the femoral artery were dissected. The number and location of the saphenous nerve branches and the features of their accompanying vessels were dissected and studied. From January 2016 to December 2017, six patients with soft tissue defects ranged from 8 × 2.5 cm to 21 × 4 cm were repaired by the free extended PTAP flap. The patients' average age was 48 years. The causes of the defects included machine injuries in three patients and traffic injuries in the other three. The defects located at the hand in three cases, foot in two cases, and ankle in one case. The flap was designed based on the perforators of the posterior tibial artery and included a branch of saphenous nerve. The perforator pedicle and the nerve branch were connected to the vessels and nerve in the recipient site, respectively. Results The saphenous nerve gave off 5.8 ± 1.1 branches, with a relatively constant one issuing 8.1 ± 0.7 cm distal to the medial femoral condyle. Every nerve branch had an accompanying vessel, which connected with the PTAPs and supplied the skin. The size of the flap ranged from 10 × 3.5 cm to 23 × 5 cm. All of the flaps survived completely without complications. Follow‐up varied from 6 to 12 months. All the patients obtained cold/hot sensation and pain sensation. The results of Semmes–Weinstein monofilament test ranged from 4.31(2 g) to 5.46 (26 g), and the 2‐point discrimination test varied from 20 to 35 mm. Conclusion The free extended PTAP flap, containing the saphenous nerve branch and its accompanying vessels, may be an alternative for large soft tissue reconstruction with improved sensation recovery.

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Section: Introductionmentioning

confidence: 99%

Free extended posterior tibial artery perforator flap with the neurovascular plexus of a saphenous nerve branch for large soft tissue and sensory reconstruction: Anatomic study and clinical application

et al. 2020

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“…With the development of locoregional perforator-and propeller flaps, the reconstructive armamentarium has been expanded further. 21,22 Nonetheless, the ALT and gracilis flaps remain workhorses for the reconstruction of complex extremity defects 23,24 and are thus the focus of the analysis.…”

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confidence: 99%

Microsurgical Reconstruction of the Plantar Foot: Long-Term Functional Outcomes and Quality of Life

Heidekrueger

Ehrl

Prantl

et al. 2019

J reconstr Microsurg

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Background When faced with plantar defects, reconstruction of the weight-bearing areas presents unique surgical challenges. Several free flap modalities have been described in this respect, but there remains debate regarding the best-suited flap modality. Aim of this study was to compare free muscle and non-neurotized fasciocutaneous flaps for plantar reconstruction with respect to long-term functional outcomes. Methods Overall, 89 patients received 100 free flaps (anterolateral thigh [ALT] n = 46; gracilis n = 54) for plantar reconstruction. The data were screened for patients' demographics, as well as perioperative details. Postoperative complications were accounted for and the two groups compared accordingly. All patients were contacted for a long-term follow-up examination. Results There were no significant differences between the two groups regarding major (24 vs. 17%; p = 0.366) and minor surgical complications (61 vs. 70%; p = 0.318). However, the ALT group showed a significantly higher need for secondary surgeries (39 vs. 19%; p = 0.022). Sixty-eight patients (76%) returned for long-term follow-up evaluation (mean: 51.2 months, range: 13–71 months). The ALT group showed significantly less pain at the recipient (p = 0.0004) and donor (p = 0.010) sites, and scar assessment revealed significantly better results (p < 0.001). Additionally, the ALT group showed better depth (p = 0.017) and superficial (p = 0.007) sensation and enabled better shoe provision (p = 0.014). Conclusion Both the free ALT and gracilis flaps are well suited for plantar reconstruction, yielding overall similar functional outcomes. However, the ALT flap produces less scarring and pain, while showing better recovery of sensation and enabling better shoe provision. The ALT flap thus presents our preferred option.

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“…Other than that, as this flap is innervated by the cutaneous branch of the medial plantar nerve, sensitization is possible, which is an important requirement for patient's ambulation [9]. Another advantage of medial plantar flap is the low donor-site morbidity [1]. As seen in our case, there were no long-or short-term donor-site complications in patient's view.…”

Section: Discussionmentioning

confidence: 54%

“…The heel of the foot is covered by highly specialized thick, glabrous skin containing fibroadipose tissue with numerous fibrous septae traversing the subcutaneous tissue to connect the skin to the plantar aponeurosis. These septae divide the subcutaneous tissue into small loculi that acts as a shock-absorbent and prevents the skin from shearing [1]. Therefore, the heel is an important integrated part for walking.…”

Section: Introductionmentioning

confidence: 99%

Heel Pad Reconstruction With Medial Plantar Flap

Langat

Sulaiman

2021

Cureus

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The heel of the foot is covered by highly specialized thick, glabrous skin containing fibroadipose tissue with numerous fibrous septae traversing the subcutaneous tissue, which acts as a shock-absorbent and prevents shearing of the skin. The loss of heel pad would cause interruption of the propelling function of the foot during walking. Therefore, heel pad reconstruction is an important procedure for wound closure in the acute phase and also functional reconstruction in delayed cases. We report a case of heel pad deformity in a patient who presented to us with left heel pain and inability to fully bear weight, which has caused her walking difficulty, following a road traffic accident. She sustained a degloving injury of the left foot and an open fracture of left calcaneum with ruptured Tendon Achilles in which the wound was initially addressed with failed reverse sural flap and the wound was allowed to heal by secondary intention. Delayed heel reconstruction was carried out with a propeller medial plantar flap and split skin graft. Postoperatively, the patient had improved functional and esthetic outcome.

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Reconstruction of Defects in the Weight-Bearing Plantar Area Using the Innervated Free Medial Plantar (Instep) Flap

Cited by 31 publications

References 25 publications

Free extended posterior tibial artery perforator flap with the neurovascular plexus of a saphenous nerve branch for large soft tissue and sensory reconstruction: Anatomic study and clinical application

Free extended posterior tibial artery perforator flap with the neurovascular plexus of a saphenous nerve branch for large soft tissue and sensory reconstruction: Anatomic study and clinical application

Microsurgical Reconstruction of the Plantar Foot: Long-Term Functional Outcomes and Quality of Life

Heel Pad Reconstruction With Medial Plantar Flap

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