The Clinical Application of Plantar Marginal Septum Cutaneous Island Flap

Abstract

Soft tissue defects complicated with exposure of tendons, bones, ligaments and joints of the forefoot usually require flap coverage to achieve wound closure and functional preservation. Many reconstructive methods had been proposed, including flaps from toes, from foot, from local or distal flaps with larger or small arteries. But the coverage remained a formidable challenge, either due to large donor size sacrifice or possible morbidity, or due to variable reliability. The plantar marginal septum cutaneous island flap (PMSC) was first reported by Bertelli et al in 1997. It served as an alternative of the conventional methods to provide coverage of the forefoot. Before the development of this flap, the overage of forefoot remained a formidable challenge. The PMSC flap is a reversed- flow flap based on the superficial branch of the medial division of the medial plantar artery. The flap has a distal anastomosis with lateral plantar artery, first dorsal metatarsal artery (FDMA) and lateral branch of the medial plantar artery at the level over the neck of the first metatarsal-phalangeal area, so it is a reliable flap. We have successfully used this flap to reconstruct complicated forefoot wounds in 5 cases. Four of the harvested flaps had totally survived and one had partially survived and later healed by skin graft. In addition, we reposition the abductior hallucis muscle to cover the donor site of flap and then skin grafted. This method solves the problem of the donor site morbidity.