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Mokfi MA, Koualla S, Jaadi D, Badaoui Z, Sqalli H, Lamtaouech R, Khales A, Achbouk A, Ababou K. [The value of the medial plantar flap in the repair of loss of soft tissue in the distal quarter of the leg]. ANN CHIR PLAST ESTH 2024; 69:117-123. [PMID: 37230925 DOI: 10.1016/j.anplas.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Soft tissue repair of the distal leg is a challenge for the surgeon. The objective of our work is to evaluate the interest of medial plantar flaps in the repair of soft tissue loss in the distal quarter of the leg, by highlighting the advantages and disadvantages of this technique. METHODS We conducted a retrospective study over 4 years in the Department of Plastic, Reconstructive and Burn Surgery of the Mohammed V Military Teaching Hospital of Rabat, including 8 patients admitted for coverage of a distal quarter of the leg with a medial plantar flap. RESULTS Eight patients were included, 5 men and 3 women with an average age of 45.5 years. All patients received coverage with a medial plantar flap. The functional and aesthetic results were very good with a low complication rate. CONCLUSION The medial plantar flap should no longer be reserved for covering loss of substance of the foot only, but should be integrated into the therapeutic arsenal of reconstruction of the distal quarter of the leg.
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Affiliation(s)
- M A Mokfi
- Service de chirurgie plastique réparatrice et des brûlés, hôpital militaire d'instruction Mohammed V, Rabat, Maroc.
| | - S Koualla
- Service des brûlés et chirurgie réparatrice, CHU de Mohammed VI, Oujda, Maroc
| | - D Jaadi
- Service de chirurgie plastique, CHU d'Ibn Sina, Rabat, Maroc
| | - Z Badaoui
- Service de chirurgie plastique réparatrice et des brûlés, hôpital militaire d'instruction Mohammed V, Rabat, Maroc
| | - H Sqalli
- Service de chirurgie plastique, CHU d'Ibn Sina, Rabat, Maroc
| | - R Lamtaouech
- Service de chirurgie plastique réparatrice et des brûlés, hôpital militaire d'instruction Mohammed V, Rabat, Maroc
| | - A Khales
- Service de chirurgie plastique réparatrice et des brûlés, hôpital militaire d'instruction Mohammed V, Rabat, Maroc
| | - A Achbouk
- Service de chirurgie plastique réparatrice et des brûlés, hôpital militaire d'instruction Mohammed V, Rabat, Maroc
| | - K Ababou
- Service de chirurgie plastique réparatrice et des brûlés, hôpital militaire d'instruction Mohammed V, Rabat, Maroc
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Laitonjam M, Khan MM, Krishna D, Cheruvu VPR, Minz R. Reconstruction of Foot and Ankle Defects: A Prospective Analysis of Functional and Aesthetic Outcomes. Cureus 2023; 15:e40946. [PMID: 37378308 PMCID: PMC10292190 DOI: 10.7759/cureus.40946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Reconstruction of foot and ankle defects requires selecting an appropriate durable and aesthetically appealing option. From the different options, the procedure's choice depends on the defect's size, location, and donor area's availability. Patients' main goal is to have an acceptable biomechanical outcome. MATERIALS AND METHODS In this prospective study, we have included patients who had undergone reconstruction of the ankle and foot defects between January 2019 and June 2021. Patient demographics, location and size of the defect, different procedures, complications, sensory recovery, ankle hindfoot score, and satisfaction score were recorded. RESULTS 50 patients with foot and ankle defects were enrolled in this study. All flaps survived except one free anterolateral thigh flap. Five locoregional flaps developed minor complications, and all skin grafts healed well. The Ankle Hindfoot Score outcome has no significant relation with the anatomical location of the defects and the reconstructive procedure. All patients reconstructed using random local flap and with free flap were satisfied with the aesthetic outcome. CONCLUSIONS Because of limited soft tissue, local flap availability is restricted to small defects. Satisfaction rates are high in local and free flaps and are best suited for reconstructing the weight-bearing part of the foot. Bulky flaps should be avoided over the dorsum and ankle region.
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Affiliation(s)
- Michael Laitonjam
- Plastic and Reconstructive Surgery, Shija Hospital and Research Institute, Imphal, IND
| | - Manal M Khan
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Deepak Krishna
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ved Prakash Rao Cheruvu
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Reena Minz
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
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Besmens IS, Zoller FE, Guidi M, Giovanoli P, Calcagni M. How to measure success in lower extremity reconstruction, which outcome measurements do we use a systematic review and metanalysis. J Plast Surg Hand Surg 2023; 57:505-532. [PMID: 36779747 DOI: 10.1080/2000656x.2023.2168274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Different factors have to be considered and weighted in the treatment algorithm of lower extremity reconstruction. A combination of both clinicians' and patients' perspectives is necessary to provide a conclusive picture. Currently, there aren't any standardized and validated measurement data sets for lower extremity reconstructions. This makes it necessary to identify the relevant domains. We, therefore, performed a systematic review and metanalysis of outcome measurements and evaluated their ability to measure outcomes after lower extremity reconstruction. A systematic review and metanalysis according to the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' protocol were performed for studies reporting at least one structured outcome measurement of lower extremity reconstruction. Both Patient (PROMs)- and Clinician reported outcome measurements (CROMs)were analyzed. Of the 2827 identified articles, 102 were included in the final analysis. In total 86 outcome measurements were identified, 34 CROMs, 44 PROMs and 8 (9.3%) outcome measurements that have elements of both. Twenty-four measure functional outcome, 3 pain, 10 sensations and proprioception, 9 quality of life, 8 satisfaction with the result, 5 measure the aesthetic outcome, 6 contours and flap stability and 21 contain multidomain elements. A multitude of different outcome measurements is currently used in lower extremity reconstruction So far, no consensus has been reached on what to measure and how. Validation and standardization of both PROMs and CROMs in plastic surgery is needed to improve the outcome of our patients, better meet their needs and expectations and eventually optimize extremity reconstruction by enabling a direct comparison of studies' results.
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Affiliation(s)
- Inga S Besmens
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Florence E Zoller
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marco Guidi
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Pietro Giovanoli
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Ou Q, Wu P, Pan D, Tang JY. Combined transfer by several perforator skin flaps to cover an extensive and multiplanar wound on the foot and ankle. J Plast Reconstr Aesthet Surg 2022; 75:3751-3760. [DOI: 10.1016/j.bjps.2022.06.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 10/17/2022]
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Krishna D, Chaturvedi G, Khan MM, Cheruvu VPR, Laitonjam M, Minz R. Reconstruction of Heel Soft Tissue Defects: An Algorithm Based on Our Experience. World J Plast Surg 2021; 10:63-72. [PMID: 34912668 PMCID: PMC8662685 DOI: 10.29252/wjps.10.3.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/12/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Sensory recovery and durability of the flap is the primary goal of heel soft tissue reconstruction. From the different options, the choice of the flap depends on the size of the defect, its location, and the availability of the donor area. METHODS In this retrospective study, 40 patients having heel defects were included from Jan 2016 to Dec 2018 in which different flaps were used for the reconstruction. The outcome was evaluated in terms of flap survival, recovery of sensation, the durability of coverage, and functional denouement. We also analysed the outcome between neuropathic and non-neuropathic ulcers of the heel. RESULTS Out of 40 patients’ medial plantar artery islanded flap was performed in eight cases, extended reverse sural flap in 16 cases, islanded reverse sural flap in six cases, local flaps in six cases, cross-leg flap in two cases, and free Latissimus Dorsi muscle flaps with Skin Graft cover in two cases. The patients were observed for a mean follow-up time of 15 months (12-20 months). Only two flaps showed marginal necrosis as an immediate complication. The majority of the flaps were tenacious in the follow-up period except for the six flaps that developed delayed ulceration. Return of protective sensation (P=0.006) and mean American Orthopaedic Foot and Ankle Society subjective score (P=0.025) was significantly higher in the non-neuropathic ulcer group. CONCLUSION Locoregional flaps can cover most of the heel defects with a satisfactory outcome. The functional outcome was lower in the reconstructed neuropathic heel ulcer group.
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Affiliation(s)
- Deepak Krishna
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, India
| | - Gaurav Chaturvedi
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, India
| | - Manal M Khan
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, India
| | - Ved Prakash Rao Cheruvu
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, India
| | - Michael Laitonjam
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, India
| | - Reena Minz
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, India
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Feng B, Dai GM, Wang YJ, Zhang L, Niu KC. The Treatment Experience of Different Types of Flaps for Repairing Soft Tissue Defects of the Heel. Int J Gen Med 2021; 14:8445-8453. [PMID: 34819752 PMCID: PMC8608019 DOI: 10.2147/ijgm.s329642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To summarize the clinical application effects of three different types of flaps for repairing soft tissue defects of the heel, and to discuss the importance of tissue repair and heel reconstruction. Methods A total of 46 cases with skin tissue defects of the heel with deep tissue exposure were treated. The reasons for the defect were trauma (n = 26), burns and electric shocks (n = 12), chronic ulcers (n = 2), postoperative infection of the calcaneus and Achilles tendon (n = 5), and tumor resection (n = 1). The scope of wound defect was 2.0×2.5 to approximately 15.0×20.0 cm. The flaps used were medial plantar island flaps (n = 9), distal pedicled sural neurovascular island flaps (n = 23), and free anterolateral thigh (perforator) flaps (n = 14). The flap cutting range was 3.0×3.5 to approximately 16.0×22.0 cm. Results After surgery, all 46 flaps survived. In two cases, patients experienced partial epidermal necrosis at the distal end of the flap that healed after local dressing exchange, and after this treatment, the complete skin grafts survived. Follow-up was conducted in 40 cases, with an average follow-up duration of 8.2 months (3-44 months) and the two-point discrimination of 5-14 mm. The average American Orthopaedic Foot and Ankle Society scale was 89.2 points with good flap color and texture, satisfactory appearance, and normal gait. Conclusion The repair method should be selected according to the"5-zone method": The plantar medial island flap is suitable for small area (<5 cm) of medial, posterior and plantar defects. The distal pedicled sural neurovascular flap is suitable for lateral, posterior, and medium-range (6-10 cm) joint area defects. The free anterolateral thigh perforator flap is suitable for large-scale (>10 cm) joint area defects.
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Affiliation(s)
- Bo Feng
- Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Inner Mongolia Medical University, Baotou, 014010, People's Republic of China
| | - Guang-Ming Dai
- Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Inner Mongolia Medical University, Baotou, 014010, People's Republic of China
| | - Yong-Jun Wang
- Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Inner Mongolia Medical University, Baotou, 014010, People's Republic of China
| | - Lan Zhang
- Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Inner Mongolia Medical University, Baotou, 014010, People's Republic of China
| | - Ke-Cheng Niu
- Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Inner Mongolia Medical University, Baotou, 014010, People's Republic of China
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Sundaramurthy N, Venkata Mahipathi SR, Durairaj AR, Jayachandiran AP, Selvaa SR. "Like For Like" Reconstruction of Heel Pad with Medial Plantar Artery Flap-Functional and Aesthetic Outcomes in A Series of 19 Cases. Indian J Plast Surg 2021; 54:358-361. [PMID: 34667524 PMCID: PMC8515316 DOI: 10.1055/s-0041-1735424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Heel pad loss can cause serious problems in weight-bearing and locomotion. The medial plantar artery (MPA) flap is a suitable “like for like” replacement. Nineteen patients whose heels were reconstructed with MPA flap between July 2015 and February 2020 were studied. All patients were assessed based on flap survival, functionality, and patient satisfaction. Loss of heel pad was due to diabetic ulcer (11), trauma (6), tumor (1), and unstable scar (1). The largest flap measured 9 × 7 cm. Sixteen flaps were done as fasciocutaneous flaps and three in combination with abductor hallucis muscle (AbdH). All the flaps survived. The average functional scores at 6, 12, 18, and 24 months were 86.86, 89.62, 89.38 and 97.33 based on AOSAS-AH score. Average patients' satisfaction was 8.7/10. To conclude, the MPA system is a versatile vascular axis providing “like for like” tissue for heel pad reconstruction which is reliable and durable.
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Affiliation(s)
- Narayanamurthy Sundaramurthy
- Department of Plastic and Reconstructive Surgery, Saveetha Medical College, Saveetha Nagar, Thandalam, Kanchipuram District, Tamil Nadu, India
| | - Surya Rao Venkata Mahipathi
- Department of Plastic and Reconstructive Surgery, Saveetha Medical College, Saveetha Nagar, Thandalam, Kanchipuram District, Tamil Nadu, India
| | - Alagar Raja Durairaj
- Department of Plastic and Reconstructive Surgery, Saveetha Medical College, Saveetha Nagar, Thandalam, Kanchipuram District, Tamil Nadu, India
| | - Anand Prasath Jayachandiran
- Department of Plastic and Reconstructive Surgery, Saveetha Medical College, Saveetha Nagar, Thandalam, Kanchipuram District, Tamil Nadu, India
| | - Shalini Ranipet Selvaa
- Saveetha Medical College, Saveetha Nagar, Thandalam, Kanchipuram District, Tamil Nadu, India
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8
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Reconstruction of Heel Soft Tissue Defects: An Algorithm Based on Our Experience. World J Plast Surg 2021. [DOI: 10.52547/wjps.10.3.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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9
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Exchange Chimeric Flap: An Effective Method to Solve the Short Plate of Medial Plantar Flap. Ann Plast Surg 2021; 88:712-713. [PMID: 34176902 DOI: 10.1097/sap.0000000000002782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Grauberger JN, Gibreel WO, Moran SL, Carlsen BT, Bakri K. Long‐term
clinical and p
atient‐reported
outcomes in free flap reconstruction of the w
eight‐bearing
heel pad and n
on‐weight‐bearing
Achilles tendon regions. Microsurgery 2020; 40:835-845. [DOI: 10.1002/micr.30658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 12/16/2022]
Affiliation(s)
| | | | - Steven L. Moran
- Division of Plastic Surgery Mayo Clinic Rochester Minnesota USA
| | | | - Karim Bakri
- Division of Plastic Surgery Mayo Clinic Rochester Minnesota USA
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11
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Opoku-Agyeman JL, Allen A, Humenansky K. The Use of Local Medial Plantar Artery Flap for Heel Reconstruction: A Systematic Review. Cureus 2020; 12:e9880. [PMID: 32963919 PMCID: PMC7500739 DOI: 10.7759/cureus.9880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Soft tissue reconstruction of the heel represents a daunting challenge for reconstructive surgeons, given the weight-bearing role and anatomical properties of the glabrous skin on the plantar surface. For soft tissue defects in this area, the medial plantar artery (MPA) flap has been described as an optimal reconstructive option. Many studies have reported on the use of the medial plantar artery flap for soft tissue coverage of the heel. There currently exists no systematic review on the topic. AIM The aim of this article is to review the literature on the use of local medial plantar artery flap for heel reconstruction with a focus on overall flap viability and selected outcomes. METHOD The authors performed a systematic literature review using EMBASE, Cochrane Library, Ovid Medicine, MEDLINE, Google Scholar, PubMed database, and grey literature. Studies were identified between 1981 and 2019. Peer-reviewed articles published in the English language were included. Articles were eligible if they contained original clinical outcomes on patients who underwent local medial plantar artery flap for reconstruction of heel defects. RESULTS A total of 135 unique studies were identified. Eighteen (18) articles were included in the review and analyses, yielding a total of 277 local medial plantar artery flaps for heel coverage. The most common etiology for the reconstructed heel defect was ulcers (45.3%) followed by trauma (35.8%). The overall complete flap survival rate was n=272/277 (98.2%). The incidence of minor flap complication was n=26/277 (9.4%). Most of the flaps maintained protective sensation (n=147/148 [99.3%]), although the protective sensation tended to be inferior to the contralateral normal side. The rate of donor site morbidity was n=14/269 (5.2%). CONCLUSION Local medial plantar artery flap for heel defect reconstruction is associated with a very high flap survival rate with very few flap related complications including donor site complications.
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Affiliation(s)
- Jude L Opoku-Agyeman
- Plastic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Amber Allen
- Foot and Ankle Surgery, Private practice, Philadelphia, USA
| | - Kayla Humenansky
- Plastic and Reconstructive Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
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Guillier D, Campisi C, Krähenbühl SM, Raffoul W, di Summa PG. Bipedicled distally based medial plantar artery perforator flap for forefoot reconstruction: A case report. Microsurgery 2020; 40:497-500. [PMID: 32243659 DOI: 10.1002/micr.30583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/18/2020] [Accepted: 03/20/2020] [Indexed: 11/09/2022]
Abstract
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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Affiliation(s)
- David Guillier
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Dijon, Dijon, France.,Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Corrado Campisi
- Lymphatic Surgery and Microsurgery ICLAS-Salus Hospital-Maria Pia Hospital, GVM Care & Research Rapallo, Reggio Emilia, Torino, Italy
| | - Swen M Krähenbühl
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Wassim Raffoul
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Pietro G di Summa
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne, Lausanne, Switzerland
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Systematic reappraisal of the reverse-flow medial plantar flap: From vascular anatomical concepts to surgical applications. J Plast Reconstr Aesthet Surg 2020; 73:421-433. [DOI: 10.1016/j.bjps.2019.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/24/2019] [Accepted: 10/20/2019] [Indexed: 11/17/2022]
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14
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Uslu AB, Ünlü RE. Heel Reconstruction With Bipedicled Flap: A Salvage Procedure. INT J LOW EXTR WOUND 2020; 19:377-381. [PMID: 32089023 DOI: 10.1177/1534734620905738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reconstruction of the heel region poses great challenge to plastic surgeons not only due to calcaneal bone lying just deep to the subdermal fat pad but also due to easily exposed Achilles tendon. In order to achieve permanent closure of the heel defect, exposed bone or tendon-or both-should be covered with durable, preferably sensate, well-vascularized, thin skin flaps. Even though fasciocutaneous free flaps remain the gold standard in the reconstruction of heel defects with exposed bone or tendon, a significant number of these patients are older individuals with multiple comorbidities such as diabetes mellitus, hypertension, atherosclerosis, and peripheral vascular disease. In this study, with a clinic series consisting of 6 patients (1 female, 5 males), we present a new technique of reconstruction with a bipedicled flap as a safe, reliable, and efficient reconstructive modality in the treatment of heel defects in cases where free flaps and other more sophisticated reconstructive options are either not feasible or have failed. Achieving complete reconstruction of defects in all 6 patients, this technique proves to be successful as a salvage procedure in reconstruction of heel defects.
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15
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Cang ZQ, Ni XD, Xu Y, Wang M, Wang Q, Yuan SM. Reconstruction of the distal lower leg and foot sole with medial plantar flap: a retrospective study in one center. J Plast Surg Hand Surg 2019; 54:40-46. [PMID: 31581878 DOI: 10.1080/2000656x.2019.1673169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Zheng-Qiang Cang
- Department of Plastic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Dong Ni
- Department of Plastic Surgery, Nanjing School of Clinical Medicine, Bengbu Medical College, Nanjing, China
| | - Yuan Xu
- Department of Plastic Surgery, Jinling Hospital, Nanjing, China
| | - Min Wang
- Department of Plastic Surgery, Jinling Hospital, Nanjing, China
| | - Qian Wang
- Department of Plastic Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Si-Ming Yuan
- Department of Plastic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, China
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Medial Plantar Artery Perforator Flap: Experience with Soft-tissue Coverage of Heel. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1991. [PMID: 30656102 PMCID: PMC6326630 DOI: 10.1097/gox.0000000000001991] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/01/2018] [Indexed: 11/26/2022]
Abstract
Background: Soft-tissue coverage is a challenge to the ankle and foot reconstructive surgeon due to its unique requirement of simultaneously withstanding body weight and to provide sensory feedback. We share our experience of medial plantar artery perforator (MPAP) flap, which provides a robust sensate coverage to heel defects. Methods: Three-year retrospective study, which included soft-tissue injury to heel. All patients underwent MPAP flap for the coverage of the defect. Patients' demographic, mode of injury, defect size, flap size and survival, time to start weight bearing, return of protective sensations, and comparative 2-point discrimination with opposite heel were studied. Results: We studied 16 cases with heel soft-tissue injuries. Fifteen had motor vehicle accident, and 1 had chronic diabetic wound. Mean surface area of flap was 4 × 5 cm. Except 1 flap, 15 flaps had complete survival and provided reliable wound coverage with comparable normal sensation as on other foot. Conclusion: We suggest that MPAP flap, when available, is a good local tissue for heel wounds coverage.
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