The rotational advancement of medial plantar flap for coverage of foot defect: A case report

Comparison of distally based sural artery and supramalleolar flap for coverage of dorsum of foot and ankle defects; a cross-sectional study of 53 patients

Background

Soft tissue defects over the foot and ankle region are most challenging in reconstructive surgery. Sural artery and supramalleolar flaps have been commonly used for the reconstruction of non-weight-bearing surfaces of the foot. This article aimed to evaluate the long-term outcome comparisons between a sural artery and Supramalleolar flap in the reconstruction of extensive defects of foot and ankle only.

Methods

Between 1996 and 2020, a retrospective analysis of 53 fasciocutaneous flaps (27 sural and 26 Supramalleolar) used for reconstruction of soft tissue defects of foot and ankle were reviewed in this study. The parameters included were demographics data, causes, site and size of the defect, flap size, hospital stay, complications, and outcomes in a pre-structured proforma. The clinical outcome was assessed by a Self-Designed Tool based on flap survival, coverage of defect, weight-bearing status, functional activities of daily living, and cosmetic appearance. Data were analyzed through SPSS version 25.

Results

Among 53 flaps, the major cause of the defect was Trauma (60.4%). The maximum flap size harvested was 25*10 for sural and 20*8 cm for supramalleolar. Complications were seen in 8 (15%) cases in both flaps. Flap tip necrosis and venous congestion were seen in 4 cases. 2 each in Supramalleolar whereas 1 partial necrosis, 1 venous congestion, and 2 infections were seen in the sural artery flap. The flap survival rate in both flaps was 96.2%. Based on the self-designed Tool, flaps were graded Excellent in 43, Good in 8, and Fair in 2 cases. There was no case of Poor in both flaps.

Conclusion

Compared with the sural artery flap, the lateral supramalleolar flap demonstrated higher rates of functional outcomes although flap tip necrosis was higher in Supramalleolar.

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The comparative long-term clinical and functional outcomes of Sural and Supramalleolar flap is based on defect coverage, cosmetic appearance of surgical limb and activity of daily living.

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Compared with the sural artery flap, the lateral Supramalleolar flap is more reliable and exhibit higher rates of functional outcomes.

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Outcomes of Supramalleolar Flap was better than Sural artery flap as it was much more vascular and robust.

[Repair of cicatricial contracture deformity of palm with modified free medial plantar flap with preserved abductor hallucis]

Objective

To investigate the effectiveness of modified free medial plantar flap with preserved abductor hallucis for repairing cicatricial contracture deformity of palm.

Methods

Between January 2012 and July 2017, a modified free medial plantar flap with preserved abductor hallucis was used to repair 9 cases of cicatricial contracture deformity at the palm. There were 7 males and 2 females with a median age of 23 years old (range, 15-40 years). The duration of cicatricial contracture was 4-23 years (mean, 9 years). In addition, 3 cases had combined stiffness of finger joints, 2 cases of tendon exposure, and 2 cases with exposed tendon and nerve. The range of flap was 4.5 cm×4.0 cm to 8.0 cm×6.0 cm. The vessel pedicle of the flap was 7-8 cm in length, with an average length of 7.5 cm. Grafting and repairing were performed with full-thickness skin graft from the ilioinguinal region in the donor site.

Results

All flaps and skin grafts survived after operation, and all wounds healed at first intention. All 9 patients were followed up 5-22 months (mean, 10 months). The flap exhibited smooth appearance and soft texture, which was similar to that of the normal skin around. The recovery time of dermal sensation was 5-12 months (mean, 9 months). At last follow-up, the flap recovered to level S ₄ in 5 cases, level S ₃ in 3 cases, and level S ₃ in 2 cases. The two-point discrimination was 6.0-10.0 mm (mean, 8.5 mm). According to the assessment of the upper limb function issued by the Hand Surgery Society of Chinese Medical Association, the hand function was excellent in 5 cases, good in 2 cases, and fair in 2 cases. Additionally, the abduction and flexion activities of the great toe of the donor foot were not affected, and the skin grafting area was slightly colored.

Conclusion

The modified free medial plantar flap for repairing cicatricial contracture deformity of palm has such advantages as no impact on abductor hallucis, small damage of the donor area, improved survival rate of skin grafting, and the unaffected function of the donor foot.

Free sensate medial plantar flap for contralateral plantar forefoot reconstruction with flap reinnervation using end-to-side neurorrhaphy: a case report and literature review

Reconstruction of weight-bearing plantar defects remains a challenge due to the unique characteristics of the plantar skin and thus the limited available options. The medial plantar flap, either pedicled or free, represents an ideal option, but its use as sensate flap for forefoot defects has been scarcely reported. We present a case of plantar forefoot reconstruction with a free sensate medial plantar flap, with end-to-side coaptation of the cutaneous sensory fascicles of the flap to the medial plantar nerve of the recipient. Last follow-up, at 2 years post-op, verified a very good functional and aesthetic outcome, indicating that the suggested approach may prove the treatment of choice in selected cases of plantar forefoot reconstruction.