Case Reports and Series| Volume 51, ISSUE 6, P790-794, November 2012

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The Medial Plantar Artery Flap: A Series of Cases over 14 Years


      Coverage of the weightbearing heel poses a unique technical challenge to the reconstructive surgeon. In the present study, we share our clinical experience with the use of the medial plantar artery-based flap for coverage of tissue defects around the heel. Eighteen medial plantar artery flaps performed from January 1996 to December 2009 were included. All the procedures were performed by 2 surgeons at Aga Khan University and Hospital (Karachi, Pakistan) and Bahawal Victoria Hospital (Bahawalpur, Pakistan). Of the 18 patients, 16 were male and 2 were female. The indications were traumatic loss of the heel pad in 13, pressure sores in 2, and unstable plantar scars in 3. All the flaps were raised as sensate fasciocutaneous pedicled flaps based on the medial plantar artery. All the flaps healed uneventfully without major complications. The donor site was covered with a split-thickness skin graft, and we had partial graft loss in 1 case. The sensate flaps had slightly inferior protective sensation compared with the normal side. From our results, we suggest that the medial plantar artery flap is a good addition to the existing armamentarium. It provides tissue to the plantar skin with a similar texture and an intact protective sensation. The technique is easier to master compared with free microvascular flaps and has less risk of any functional donor site morbidity.

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        • El-Shazly M.
        • Yassin O.
        • Kamal A.
        • Makboul M.
        • Gherardini G.
        Soft tissue defects of the heel: a surgical reconstruction algorithm based on a retrospective cohort study.
        J Foot Ankle Surg. 2008; 47: 145-152
        • Bach A.D.
        • Leffler M.
        • Kneser U.
        • Kopp J.
        • Horch R.E.
        The versatility of the distally based peroneus brevis muscle flap in reconstructive surgery of the foot and lower leg.
        Ann Plast Surg. 2007; 58: 397-404
        • Ozturk S.
        • Bayram Y.
        • Mohur H.
        • Deveci M.
        • Sengezer M.
        Evaluation of late functional results of patients treated with free muscle flaps for heel defects caused by land-mine explosions.
        Plast Reconstr Surg. 2005; 116: 1926-1936
        • Ulusal B.G.
        • Lin Y.T.
        • Ulusal A.E.
        • Lin C.H.
        • Yen J.T.
        Reconstruction of foot defects with free lateral arm fasciocutaneous flaps: analysis of fifty patients.
        Microsurgery. 2005; 25: 581-588
        • Shanahan R.E.
        • Gingrass R.P.
        Medial plantar sensory flap for coverage of heel defects.
        Plast Reconstr Surg. 1979; 64: 295-298
        • Mathes S.J.
        • Nahai F.
        Reconstructive Surgery: Principles, Anatomy and Technique.
        Churchill Livingstone, New York1997
        • Ponten B.
        The fasciocutaneous flap: its use in soft tissue defects of the lower leg.
        Br J Plast Surg. 1981; 34: 215-220
        • Harrison D.H.
        • Morgan B.D.
        The instep island flap to resurface plantar defects.
        Br J Plast Surg. 1981; 34: 315-318
        • Duman H.
        • Er E.
        • Isik S.
        • Turegun M.
        • Deveci M.
        • Nisanci M.
        Versatility of the medial plantar flap: our clinical experience.
        Plast Reconstr Surg. 2002; 109: 1007-1012
        • Mourougayan V.
        Medial plantar artery (instep flap) flap.
        Ann Plast Surg. 2006; 56: 160-163
        • Schwarz R.J.
        • Negrini J.F.
        Medial plantar artery island flap for heel reconstruction.
        Ann Plast Surg. 2006; 57: 658-661
        • Micks J.E.
        • Wilson J.N.
        Full-thickness sole-skin grafts for resurfacing the hand.
        J Bone Joint Surg Am. 1967; 49: 1128-1134
        • Taylor G.I.
        • Palmer J.H.
        The vascular territories (angiosomes) of the body: experimental studies and clinical applications.
        Br J Plast Surg. 1990; 43: 1
        • Attinger C.E.
        • Evans K.K.
        • Bulan E.
        • Blume P.
        • Cooper P.
        Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization.
        Plast Reconstr Surg. 2006; 117: 261S-293S
        • Skef Z.
        • Ecker Jr., H.A.
        • Graham III, W.P.
        Heel coverage by a plantar myocutaneous island pedicle flap.
        J Trauma. 1983; 23: 466-472
        • Gravem P.E.
        Heel ulcer in leprosy treated with fasciocutaneous island flap from the instep of the sole.
        Scand J Plast Reconstr Surg Hand Surg. 1991; 25: 155-160
        • Rashid M.
        • Hussain S.S.
        • Aslam R.
        • Illahi I.
        A comparison of two fasciocutaneous flaps in the reconstruction of defects of the weight-bearing heel.
        J Coll Physicians Surg Pak. 2003; 13: 216-218
        • Benito-Ruiz J.
        • Yoon T.
        • Guisantes-Pintos E.
        • Monner J.
        • Serra-Renom J.M.
        Reconstruction of soft-tissue defects of the heel with local fasciocutaneous flaps.
        Ann Plast Surg. 2004; 52: 380-384
        • Miyamoto Y.
        • Ikuta Y.
        • Shigeki S.
        • Yamura M.
        Current concepts of instep island flap.
        Ann Plast Surg. 1987; 19: 97-102