Free medial plantar flap for treatment of palm and wrist large area skin defects

Abstract

Objective To discuss the clinical effect of medial plantar flap with cutaneous branch of medial plantar nerve for repair of large area skin defects in palm and wrist. Methods From January 2008 to January 2016, 16 patients with palm and wrist soft tissue defects were treated by medial plantar flap with cutaneous branch of medial plantar nerve. Among them, 10 cases were combined with tendon exposure and 4 cases with bone fractures. The skin defect area ranged from 6 cm×5 cm to 12 cm×10 cm. The harvested flap area ranged from 7 cm×6 cm to 13 cm×11 cm. The skin sensation was reconstructed by cutaneous neurorrhaphy. Results Postoperative follow-up ranged from 6 to 24 months with an average of 12 months. Partial flap necrosis occurred in 1 case and completely healed after dressing change. All the rest survived uneventfully. The two-point discrimination was 6 to 12 mm. Sensation recovery was satisfactory without physical discomfort. The texture of the flaps was close to normal skin with satisfactory appearance and wear resistance. The skin graft of donor site achieved primary healing without significant effect on walking. Conclusion The medial plantar flap has the advantages of larger cutting area, homologous anatomical structure and similar texture between foot and hand, and containing cutaneous nerve to reconstruct sensation. It is one of the ideal flaps for repair of palm and wrist large area skin defects. Key words: Surgical flaps; Treatment outcome; Medial plantar flap; Wound repair