Strategies for Reconstruction of the Plantar Surface of the Foot: A Systematic Review of the Literature

Abstract

Background: Reconstruction of the plantar surface of the foot is challenging because of its distinctive anatomy and microarchitecture. Unfortunately, no single coverage option meets the needs of all patients and defects. A comprehensive literature review is presented to better define available reconstructive options for resurfacing the plantar foot. Methods: A systematic literature search was performed to identify articles relating to reconstruction of the plantar skin and soft tissue. The PubMed, Embase, and Scopus databases were queried for published articles. After the exclusion of duplicate records, 1624 articles were available for review. A total of 280 unique articles were included for analysis, with a total of 2684 individual reconstructions. Results: Of the articles reviewed, 10 percent described a skin grafting technique, 53 percent described a locoregional flap, 32 percent described free tissue transfer, and 5 percent described multiple reconstructive methods. Isolated heel defects were the most frequently reconstructed subunit of the plantar foot (73 percent). The latissimus dorsi muscle was the most commonly used free flap, whereas the reverse sural artery flap was the most commonly used locoregional flap. Protective sensation was noted in most locoregional and free flap reconstructions, regardless of primary neurotization; however, improved two-point discrimination was noted when neurofasciocutaneous flaps were used. Complication rates varied widely, although rates of flap loss approached those of flaps performed at other anatomical sites. Conclusions: Numerous methods exist for reconstructing the plantar surface. Proper flap selection should be determined by the size of the defect, the availability of donor tissue, and the surgeon’s experience and comfort with the reconstructive technique.

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.…”

“…The medial plantar, gluteal, and back skin usually have thick dermis, but the upper lateral thigh had the thickest dermis among the considered skin flap donor sites in the present case. A TFLtp flap is considered an optimal method in this case, although other flaps can be used for heel reconstruction such as, medial plantar flap, latissimus dorsi flap and ALT flap (Crowe et al, 2019). To our knowledge, this is a first report of a true‐perforator‐based TFL flap for heel reconstruction.…”

Fluorescence angiography-assisted debridement of critically perfused glabrous skin in degloving foot injuries

“…The epidermal layer is significantly thicker with ∼1.4 mm when compared to the integument of other anatomical areas. [ 5 , 6 ] Moreover, numerous fibrous septae anchor the cutaneous tissue to the plantar aponeurosis, resulting in lower shearing forces during ambulation and lobules of subcutaneous adipose tissue serve as an optimal shock absorbent. [ 7 , 8 ] Finally, the plantar sensitivity allows precise pressure detection, which is essential for weight redistribution while standing.…”

“…[ 7 , 8 ] Finally, the plantar sensitivity allows precise pressure detection, which is essential for weight redistribution while standing. [ 5 ]…”

Reverse Sural Flap for Repair of Foot and Ankle Defects: Our Cases, Modifications, and a Literature Review

“…A reverse-flow sural flap is an ideal option for lower extremity repairs. Several clinical, anatomical, and experimental studies have been conducted in the last 20 to 30 years regarding this procedure 1- 42 ; nevertheless, publications on interpolation flap modifications are very limited. 42 The fact that it does not require complicated procedures increases the value of this flap procedure, especially in clinics where microsurgery is not available.…”