Distally Based Medial Plantar Flap: A Classification of the Surgical Techniques

Bonte, Amandine; Bertheuil, Nicolas; Menez, Tiphaine; Grolleau, J.-L.; Herlin, Christian; Chaput, Benoît

doi:10.1053/j.jfas.2018.03.027

Cited by 7 publications

(4 citation statements)

References 38 publications

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“…The MPAP flap is widely used for reconstruction of the weight-bearing area of the foot and provides excellent results. 2,6,19 Although donor site morbidity is minimal, skin grafting of the donor site can result in complications 4,20–23 including depression deformity, hyperpigmentation, medial plantar contracture, hyperkeratosis, and walking disability. 7,24 The grafted area is not robust with thick skin and may not withstand the shear and stress forces to which it is exposed on a daily basis.…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, the donor site is covered by a split or full thickness skin graft. 5,6 Exposure of the plantar aponeurosis after flap harvesting increases the risks of skin graft failure and delayed wound healing. 7,8 After skin grafting, depression deformity, hyperpigmentation, medial plantar contracture, skin hyperkeratosis, and walking disability may occur.…”

Section: Introductionmentioning

confidence: 99%

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Super-thin anterolateral thigh flap for reconstruction of the medial plantar artery perforator flap donor site

Zhou

Zhang

et al. 2023

J Orthop Surg (Hong Kong)

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Background The medial plantar artery perforator (MPAP) flap is widely used to reconstruct the weight-bearing area of the foot. Traditionally, its donor site is closed using a skin graft, which is associated with several complications, including walking disability. This study aimed to examine our experience with using a super-thin anterolateral thigh (ALT) flap to reconstruct the MPAP flap donor site. Methods We examined 10 patients who underwent reconstruction of the MPAP flap donor site using a super-thin ALT flap between August 2019 and March 2021. The vascular pedicle was anastomosed to the proximal end of the medial plantar vessels or the end of the posterior tibial vessels. Results All reconstruction flaps survived and all patients were satisfied with the aesthetic appearance. No blisters, ulcerations, hyperpigmentation, or contractures occurred. All patients gained protective sensation in the super-thin ALT flap. The average visual analog scale score for the aesthetic appearance of the reconstructed foot was 8.5 ± 0.7 (range, 8–10). All patients were able to ambulate without aids and could wear regular shoes. The average revised Foot Function Index score was 26.4 ± 4.1 (range, 22–34). Conclusion Reconstruction of the MPAP flap donor site using a super-thin ALT flap is reliable and provides satisfactory functional recovery, aesthetic appearance, and protective sensation while minimizing postoperative morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Super-thin anterolateral thigh flap for reconstruction of the medial plantar artery perforator flap donor site

Zhou

Zhang

et al. 2023

J Orthop Surg (Hong Kong)

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“…Therefore, the durable and reliable flap that can withstand the stresses and loads posed every day by body weight is needed. Based on the principle of plastic surgery, replacing “like with like” with minimal donor site morbidity and without sacrificing a major vessel, the reverse medial plantar flap (RMPF) raised from the nonweight-bearing region of the plantar foot represents a viable option 3–6 . The anatomical basis of RMPF is the complex anastomotic branches between medial plantar artery (MPA) and deep plantar arch 7–9 .…”

mentioning

confidence: 99%

“…Based on the principle of plastic surgery, replacing "like with like" with minimal donor site morbidity and without sacrificing a major vessel, the reverse medial plantar flap (RMPF) raised from the nonweight-bearing region of the plantar foot represents a viable option. [3][4][5][6] The anatomical basis of RMPF is the complex anastomotic branches between medial plantar artery (MPA) and deep plantar arch. [7][8][9] Those anastomotic branches have high variation rate and may be damaged by trauma such as electric injury.…”

mentioning

confidence: 99%

Application of Digital Subtraction Angiography in Reconstruction of Plantar Forefoot With Reverse Medial Plantar Flap

Cang

Wang

et al. 2020

Ann Plast Surg

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The reverse medial plantar flap (RMPF) raised from the nonweight-bearing region of the plantar foot represents a viable option for the soft tissue defect in planter forefoot. The anatomical basis of RMPF is the complex anastomotic branches between medial plantar artery (MPA) and deep plantar arch. Those anastomotic branches have high variation rate and may be damaged by trauma such as electric injury. Therefore, it is very important to know whether those anastomotic branches are present and intact before harvesting RMPF. Five patients with soft tissue defect in planter forefoot were enrolled into the study. The digital subtraction angiography (DSA) was performed to evaluate the plantar hemodynamics in the ipsilateral foot. The RMPF was harvested only after the anastomotic connections between MPA and deep plantar arch was confirmed. Anastomosis between superficial branch of MPA and deep plantar arch was observed in all DSA examinations. All 5 patients received the repair of soft tissue defect in plantar forefoot with RMPF. All flaps survived completely. The DSA can effectively evaluate the blood supply basis of RMPF and provide imaging evidence for the design and harvest of the flap. The main anatomical basis of RMPF is the anastomotic connections between superficial branch of MPA and deep plantar arch.

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Bipedicled distally based medial plantar artery perforator flap for forefoot reconstruction: A case report

Garcı́a-Dorado

Campisi²,

Krähenbühl

et al. 2020

Microsurgery

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Reconstruction of soft‐tissue defects in the foot weight‐bearing area should encompass sensate and robust skin. Regarding forefoot defects, distally based medial plantar artery (MPA) flap is an ideal option. However, considering variation of the terminal branches of the MPA, reverse flow flaps can be unreliable with an increasing risk of venous congestion or insufficient arterial flow. In this report, we present a case of the use of reverse flow MPA flaps with dual flow vascularization. The patient was a 37‐year‐old female who presented a 7 × 3 cm soft‐tissue defect of the right forefoot after wide local excision following melanoma. Reconstruction happened with a perforator distally based bipedicled flap (8 × 4 cm) on the MPA though keeping an enhanced vascularization through both superficial (sMPA) and deep (dMPA) medial plantar arteries. Donor site was closed with skin graft. Patient was discharged from hospital at postoperative Day 10 and healed uneventfully with progressive start walk was possible again. A full weight bearing with normal shoes was possible after 8 weeks. Good healing and no functional impairment were present after 9 months of follow‐up. We believe this dual vascularization concept may be adopted when possible to improve the overall circulation of the flap and to prevent risks of vascular insufficiency or vein congestion.

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Distally Based Medial Plantar Flap: A Classification of the Surgical Techniques

Cited by 7 publications

References 38 publications

Super-thin anterolateral thigh flap for reconstruction of the medial plantar artery perforator flap donor site

Super-thin anterolateral thigh flap for reconstruction of the medial plantar artery perforator flap donor site

Application of Digital Subtraction Angiography in Reconstruction of Plantar Forefoot With Reverse Medial Plantar Flap

Bipedicled distally based medial plantar artery perforator flap for forefoot reconstruction: A case report

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