Versatility of the Medial Plantar Flap: Our Clinical Experience

Abstract

The medial plantar flap presents an ideal tissue reserve, particularly for the reconstruction of the plantar and palmar areas, which require a sensate and unique form of skin. In the past 5 years, the authors performed 16 free flaps, 10 locally pedicled flaps, and five cross-leg flaps on 31 patients for the reconstruction of palmar and plantar defects. All flaps transferred to the palmar area survived, providing good color match and sufficient bulkiness. The overall results were satisfactory in terms of function and sensation, and no complications related to flap survival in the plantar area were observed. All flaps used to cover defects in the heel and ankle region adapted well to their recipient areas, and all lower extremities remained functional. Because the medial plantar flap presents glabrous, sensate skin with proper bulkiness and permits the movement of underlying structures, the authors advocate its use and view this procedure as an excellent alternative in the reconstruction of palmar and plantar weight-bearing areas.

The Lateral Plantar Artery as Recipient Vessel for Microsurgical Lateral Plantar Forefoot Reconstruction: Case Report

“…When the defect is large (>100 cm2) or the foot is severely traumatized, a reconstruction with free flaps is indicated [16]. Although the best flap type has not yet been determined, the instep flap, due to its similar viscoelasticity to the plantar forefoot skin, is undoubtedly the first choice [2,5,16,17] Thin perforator flap (< 6 mm in thickness), composed of small fat lobules invested by dense fibrous septa allowing less gliding, is another optimal choice [4,7]. Furthermore, sensate coverage is available by including branch of medial plantar nerve with the medial plantar flap, which is crucial for plantar defect reconstruction.…”

Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot

“…Moreover, this flap provides the ideal thickness and adapts well to the receiving area. The fibrous septa that bind the plantar skin to the plantar aponeurosis construct fat loculations that produce a shock-absorbing system (9). Therefore, the flap has the durability to withstand the pressures and shear stress of body weight (7,10,11).…”

“…The method was popularized during the 1980s, and today, the medial plantar flap has been widely used for heel and plantar reconstruction. It has been applied to tissue defects after trauma, tumor ablative surgery, chronic ulcers, open amputation stamping, unstable scarring, and electronic injury (7)(8)(9)(10). The flap has the ideal thickness and durability to withstand the pressures and shear stress of body weight.…”

Lower extremity reconstruction

“…Probably, the most versatile local flap of the foot, especially to reconstruct the heel, is the medial plantar artery flap (Fig. 1) [22]. However, the use of this flap requires that the posterior tibial vessels be intact because they supply the medial plantar vessels.…”