Various Applications of the Medial Plantar Flap to Cover the Defects of the Plantar Foot, Posterior Heel, and Ankle

Abstract

The medial plantar fasciocutaneous flap provides structurally similar tissue to plantar foot, posterior heel, and ankle defects with its thick glabrous plantar skin, shock-absorbing fibrofatty subcutaneous tissue, and plantar fascia. During the past 4 years, 24 patients (20 men, 4 women) with skin and soft-tissue defects over the plantar foot, posterior heel, or ankle were treated. They ranged in age from 20 to 42 years (mean, 24 y). The medial plantar flap was transposed to the defects in four different ways: proximally pedicled sensorial island flaps (N = 18), reverse-flow island flaps (N = 2), free flaps (N = 2), and cross-foot flaps (N = 2). Flap size varied from a width of 2 to 5.5 cm and a length of 5 to 7.5 cm. The follow-up period ranged from 2 to 18 months (mean, 9 mo). Partial flap loss was observed in one free flap and one reverse-flow island flap. Partial skin graft lost in the donor site required regrafting in one patient. Durable, sensate coverage of the defects was achieved in all patients.

Instep free flap for plantar soft tissue reconstruction: Indications and options

“…Instep flaps are fasciocutaneous flaps from the nonweight-bearing instep area. [1][2][3][4][5] They can be raised as pedicled flaps, 3,5,6,[7][8][9][10][11][12] cross-foot flaps, 1,2,13 or free flaps, 6,7,[14][15][16] and include the same anatomical features that are unique to the plantar skin, namely a thin layer of subcutaneous fat and dense fibrous septae anchoring the skin to the underlying fascia. [5][6][7] This anatomical unit serves as a shock-absorbing pad.…”

“…13 Yet, only few instep free flaps have been reported for reconstruction of plantar and palmar defects. [14][15][16] In our patient, severe trauma of the mid-and forefoot obviated the use of an ipsilateral instep flap for reconstruction of a complex defect of the plantar forefoot. Therefore, a contralateral sensate, instep free flap was employed for soft tissue reconstruction.…”

“…[3][4][5]7 The donor site in a nonweight-bearing area could easily be closed with a skin graft, and flap harvest was associated with minimal donor-site morbidity. The pedicled cross-foot flap 1,2,13 and ultimately the instep free flap 6,7,14,16 expanded the application of the instep flap to the reconstruction of plantar defects in situations where the ipsilateral instep was not available for flap harvest. Retrograde-flow medial plantar island flaps have been described for limited size defects of the distal forefoot, toe, and webspace.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The instep island flap was originally developed to cover moderate size defects of the ipsilateral heel. [1][2][3][4][5] Favorable features of the instep flap include the unique anatomy of the plantar skin that cannot be replaced by unspecialized skin from distant sites, a constant and reliable blood supply, and the option to include a cutaneous nerve for protective and tactile sensation.…”

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.…”