Proximally pedicled medial plantar flap based on superficial venous system alone for venous drainage

Non-microsurgical skin flaps for reconstruction of difficult wounds in distal leg and foot

PURPOSE

To express the versatility of a variety of non-microsurgical skin flaps used for coverage of difficult wounds in the lower third of the leg and the foot over 4 years period. Five kinds of flaps were used. Each flap was presented with detailed information regarding indication, blood supply, skin territory and technique.

METHODS

Altogether 26 patients underwent lower leg reconstruction were included in this study. The reconstructive procedures applied five flaps, respectively distally based posterior tibial artery perforator flap (n = 8), distally based peroneal artery perforator flap (n = 4), distally based sural flap (n = 6), medial planter artery flap (n = 2) and cross leg flaps (n = 6).

RESULTS

In all cases, there were no signs of osteomyelitis of underlying bones or discharge from the undersurface of the flaps. Fat necrosis occurred at the distal end of posterior tibial artery perforator flap in one female patient. The two cases of medial planter artery flap showed excellent healing with closure of donor site primarily. One cross leg flap had distal necrosis.

CONCLUSION

Would at lower third of leg can be efficiently covered by posterior tibial, peroneal artery and sural flaps. Heel can be best covered by nearby tissues such as medial planter flap. In presence of vascular compromise of the affected limb or exposure of dorsum of foot, cross leg flap can be used.

Reconstruction of Heel Soft Tissue Defects Using Medial Plantar Artery Island Pedicle Flap: Clinical Experience and Outcomes Analysis

We report our clinical experience with 11 cases of heel soft tissue defects treated with a medial plantar artery island pedicle flap. We also evaluated the functional outcomes of reconstruction. We enrolled 11 patients (10 [90.9%] males and 1 [9.1%] female), who received a medial plantar artery island pedicle flap for heel soft tissue defects from August 2010 to July 2014. The cause of the defects included trauma (post-traumatic heel skin necrosis) in 2 (18.2%) patients, infection (calcaneal osteomyelitis with overlying soft tissue infection) in 2 (18.2%) patients, and tumor (stage IA melanoma) in 7 (63.6%) patients. The mean average size of the defect was 3.7 cm × 4.4 cm (range 3.1 cm × 4.0 cm to 4.5  cm × 5.5  cm). The mean follow-up period was 19.6 (range 8 to 35) months, and all flaps survived within that period. The mean static 2-point discrimination was 34.4 (range 29 to 40) mm at the heel and 17.2 mm at the distal sole. The mean visual analog scale score for the aesthetic appearance of the reconstructed heel was 9 (range 8 to 9.5). The average revised Foot Function Index score was 25.8 (range 21 to 37). The medial plantar artery island pedicle flap is a versatile and effective method for reconstructing heel soft tissue defects.