Medial Plantar Flap Research Articles

The retrospectively analysis of risk factor with free transplanted compound tissue necrosis

Objective To analyse the risk factor of vascular crisis following free compound tissue transplantation in order to avoid the risk factor and improve the survival rate of free compound tissue. Methods Sixteen patients with free compound tissue transplantation were retrospectively reviewed between June, 2010 and December, 2015. The age, sex, injury reason, operation time, injury site and donor vessel of the patients were recorded and analysed.The risk factors of free transplanted compound tissue necrosis were concluded. Results Of 16 cases, 5 cases were anterolateral thigh flap, 4 cases medial peroneal artery flap, 2 cases osteocutaneous flap, 1 case toe transplantation, 1 case medial plantar artery flap, 1 case forearm reverse interosseous posterior artery flap and 1 case groin flap. In 16 patients with free compound tissue transplantation, there was no difference in sex and age (P>0.05) . The percentage was higher in the patients injured by vehicle than the patients injured by non-vehicle (P<0.05) . The percentage was lower in the patients with operation within 4 weeks after wound than beyond 4 weeks (P<0.05) .Transplanted tissue necrosis was prone to appear in the patients with low limb injury. The incidence of transplanted tissue necrosis was higher in low limb than in upper limb, and the highest in foot (P<0.05) . If the donor vessel was the dorsalis pedis artery, anterior tibial artery or posterior tibial artery, the incidence of transplanted tissue necrosis was very high. The highest rate was the dorsalis pedis artery (P<0.05) . Conclusion Injury by vehicle, surgery happening beyond 4 weeks after wound and injury in low limb were the high risk factor of tissue necrosis following free compound tissue transplantation. Key words: Surgical flap; Vascular crisis; Necrosis; Risk factor; Retrospectively analusis

Reconstrução de lesões de partes moles de pé com o uso de retalho plantar medial

ObjectiveTo study use of the medial plantar flap for reconstruction of the heel and foot. MethodThe authors share their clinical experience with the use of the medial plantar artery flap for coverage of tissue defects around the foot and heel after trauma. Twelve cases of medial plantar artery flap performed from January 2001 to December 2013 were included. ResultsOf the 12 patients, ten were male and two were female. The indications were traumatic loss of the heel pad in ten cases and the dorsal foot in two cases. All the flaps healed uneventfully without major complications, except one case with partial flap loss. The donor site was covered with a split‐thickness skin graft. The flaps had slightly inferior protective sensation compared with the normal side. ConclusionFrom these results, the authors suggest that the medial plantar artery flap is a good addition to the existing armamentarium for coverage of the foot and heel. It is versatile flap that can cover defects on the heel, over the Achilles tendon and plantar surface, as well as the dorsal foot. It provides tissue to the plantar skin with a similar texture and intact protective sensation.

Reconstruction of Calcaneous Region after Melanoma Excision with Extended Medial Plantar Flap: Case Report

Introduction: Acral melanoma has some distinct characteristics of the other melanoma subtypes as a higher frequency of local involvement. This leads to surgical treatment with wide margins of deep and peripheral resection, causing significant tissue loss with frequent exposure of the bone ends. The medial plantar flap uses the skin of the plantar cavus area, an ideal tissue for reconstruction of the calcaneous area. Objective: To report a case of calcaneal region reconstruction with medial plantar flap after melanoma excision. Case report: Patient, female, had a lesion diagnosed on the right foot in medical consultation due to unicomycosis. There were no complaints related to the injury. The biopsy revealed malignant acral lentiginous melanoma with a Breslow thickness of 1.9 mm, surgical margins free of neoplastic involvement and T2NxMx pathological staging. After the anatomopathological result, a 2 cm margin magnification was programmed with extensive resultant defect. The plastic surgery team opted for immediate reconstruction with ipsilateral extended medial plantar flap and graft of the donor area. Conclusion: The medial plantar flap provides adequate coverage for the calcaneal region, resistant to local inherent traumas of the region, with low morbidity in the donor area, good esthetic effect, rare complications, easy reproducibility and satisfactory functional recovery. It can be extended including a lateral plantar artery depending on the case, besides being able to remove the graft from the flap itself to avoid an increase in morbidity in other areas.

The medial plantar flap: a case series

The medial plantar flap: a case series

REPAIR OF PALM SOFT TISSUE DEFECT WITH MEDIAL TARSAL COMBINED WITH MEDIAL PLANTAR FLAP PEDICLED WITH FREE DORSALIS PEDIS ARTERY

To investigate the effectiveness of medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery in the repair of palm soft tissue defect. Between September 2013 and December 2015, 9 cases of palm soft tissue defects were repaired with medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery. There were 7 males and 2 females with a mean age of 33 years (range, 21-52 years). The causes included traffic accident injury in 4 cases, crushing injury by heavy object in 3 cases, and electrical injury in 2 cases. The time between injury and admission was 3 hours to 2 days (mean, 9 hours). Five cases had pure soft tissue; combined injuries included tendon exposure in 2 cases, median nerve defect in 1 case, and exposure of tendon and nerve in 1 case. After debridement, the soft tissue defect area ranged from 6 cm×4 cm to 11 cm×6 cm. The flap size ranged from 7.0 cm×4.5 cm to 13.0 cm×7.0 cm. The vascular pedicle length was from 6 to 10 cm (mean, 7.5 cm). The donor sites were covered with ilioinguinal full thickness skin graft. Nine flaps survived, primary healing of wound was obtained. Partial necrosis occurred at the donor site in 1 case, and the other skin graft successfully survived. All patients were followed up 6-20 months (mean, 10 months). All flaps had soft texture and satisfactory appearance; the cutaneous sensory recovery time was 4-7 months after operation (mean, 5 months). At last follow-up, sensation recovered to grade S4 in 4 cases, to grade S3+ in 3 cases, and to grade S3 in 2 cases; two-point discrimination was 7-10 mm (mean, 8.5 mm). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the hand function was excellent in 5 cases, good in 3 cases, and fair in 1 case. The donor foot had normal function. The medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery can repair soft tissue defect of the palm, and it has many advantages of soft texture, satisfactory function, and small injury at donor site.

Free Medial Plantar Flap Connection with a Posterior Tibial Artery Flap in Reconstruction of Fore-Mid Foot Skin Defect.

Background:Although there are many surgical treatments for covering the skin defect of the fore–mid foot, how to reconstruct the weight-bearing region remains a challenge. The weight-bearing region of the sole needs to withstand the pressure and shearing stresses of walking, so the plantar skin is anatomically different from other skins in the areas of texture, thickness, subcutaneous tissue, etc. Medial plantar flaps that are harvested from the instep region are regarded as the first choice for weight-bearing region reconstruction because of their excellent functional and aesthetic long-term result. However, when facing an extensive skin defect on a weight-bearing area such as a fore–mid foot avulsion, the application of this flap is limited because if we put the flap in a weight-bearing area of the forefoot, the set of vessels will be exposed to outside.Methods:We suggest 2 connected free flaps (posterior tibial artery flap and medial plantar flap) pedicled with 1 set of vessels. The medial plantar flap was used to cover the skin defect of the weight-bearing area in the forefoot. The dorsal skin defect of the injured foot was covered with a posterior tibial artery flap and supplied the medial plantar flap with the posterior tibial vessel. The midfoot skin defect was repaired by a full-skin grafting.Results:Long-term follow-up results showed that the shape and function of the injured limbs recovered almost entirely.Conclusion:This method of connected flaps is suitable for repairing large skin defects of the fore–mid foot.

Dorsalis Pedis Artery-based Flap to Cover Nonhealing Wounds Over the Tendo Achillis—A Case Series: 用足背動脈蒂皮瓣來覆蓋非癒合的跟腱手術傷口—系列病例報告

Background/PurposeSoft tissue necrosis after the repair of a ruptured tendo Achillis is a difficult problem commonly encountered by orthopaedic surgeons. Such wounds are difficult to manage because of the tenuous blood supply and the characteristic anatomical features of the area. Flaps such as the reverse sural flap, medial plantar flap, gastrocnemius flap and free flaps cover such wounds with a good success rate. The aim of our study was to investigate the use of a dorsalis pedis artery (DPA)-based flap to cover a wound over the tendo Achillis insertion area. MethodsWe report a series of 11 patients in whom wounds over the tendo Achillis insertion area were covered with a DPA-based flap. Between 1995 and 2012, 11 patients (nine men and two women), who were referred to us with a nonhealing wound over the tendo Achillis because of soft tissue necrosis after the open repair of a ruptured tendon, were selected for soft tissue coverage of the wound by using a DPA-based flap. ResultsThe average follow-up period was 2.4 years (range, 1–6 years). The mean operative time was 1.7 hours (range, 1.5–2.0 hours). At the latest follow-up examination, the flaps had survived in all patients. ConclusionA DPA-based flap is a good and relatively less complex procedure to use to cover defects over the tendo Achillis with minimum donor site morbidity.

RECONSTRUCTIVE MICROSURGERY IN THE TREATMENT OF SURFACE FORMS OF CALCANEal OSTEOMYELITIS

One of the most common complications associated with the treatment of calcaneus fracturesis, a necrosis of the edges of the surgical wound and as a result – chronic nonhealing ulcers of the heel region and osteomyelitis of the calcaneus. In the structure of skeletal lesions osteomyelitic chronic osteomyelitis of the calcaneus occurs in 3.1–14.8% of cases, and in relation to the bones of the foot – up to 51%. At the same time after open fractures of the total incidence of deep infection from soft tissue even higher than that for the surface (12.2% vs. 9.6%). The traditional approach to the treatment of osteomyelitis of the calcaneus is often accompanied by poor performance with recurrent osteomyelitis process and highsubsequent disability of working age.Objective: to identify opportunities and assess the effectiveness of the use of reconstructive microsurgery techniques in the treatment of patients with superficial forms of osteomyelitis of the calcaneus, accompanied by the presence of soft tissue defect.Materials and мethods.The results of treatment of 28 patients with superficial forms of osteomyelitis of the calcaneus, which in the period from 2006 to 2013 in RNIITO them. R.R.Vredena were performed reconstructive plastic surgery using microsurgical techniques. Defects covering tissues were located on the sole (20) and back-side surfaces (8) of the calcaneus. Scope of interventions included the radical surgical treatment of osteomyelitis focus, marginal resection of the affected heel bone and tissue replacement of defect cover flap with axial blood supply.Results. With the localization of the defect cover tissues to non-reference surface of the heel region was carried out free plastic ray skin-fascial flap (9 cases). When the location of the defect on the plantar surface of the heel region favored medial plantar flap (10 cases). However, the presence of scarring and damage to the medial plantar artery was performed two-step replacement of defect prefabrikovannym flap medial arch of the foot (9 cases). Complications were observed in 7% of cases (2 patients) in 1 patient who had undergone plastic free radial flap in 1 case – after replacing a defect medial plantar flap. In both cases they were associated with impaired blood supply to the flap and ended necrosis of transplanted grafts. In the remaining cases (93%) failed to achieve full engraftment. Long-term results were followed up in 78,5% (n = 22) of patients in the period from 1 to 8 years after the end of treatment. In four cases, the plantar surface of the calcaneus formed edge wound defects, require additional surgical treatment. on the AOFAS scale results averaged 85 points, that, given the severity of the disease, regarded as a good result.Conclusions. The use of microsurgical techniques for the treatment of patients with superficial forms of osteomyelitis of the calcaneus, including the presence of soft tissue defect, achieves sustained remission osteomyelitic process and restore support ability of the injured limb. Thus the support surface for the replacement of the heel region is expedient to use grafts comprising the plantar surface of the foot skin.

An Algorithm for Forefoot Reconstruction With the Innervated Free Medial Plantar Flap.

Because of shearing forces, the forefoot is more prone to trophic ulcers than the heel. Reconstruction of trophic ulcers and other forefoot defects is a vexing challenge. We favor the innervated free medial plantar flap to replace like-with-like and confer protective sensation. We investigate the feasibility of this flap with the largest series to date and the first to describe ipsilateral flap transfer. Between 2009 and 2013, 7 patients with forefoot defects were treated with innervated free medial plantar flaps. The average age of 4 men and 3 women was 35.1 years (range, 8-50 years). Indications were secondary reconstruction after trauma and coverage of oncologic defects. The mean defect was 5 × 7 cm (range, 4-6 cm × 6-10 cm). Four patients were treated with contralateral flaps and 3 with ipsilateral flaps using interposition vein graft. The mean flap size was 8.1 ± 1.6 cm × 5.9 ± 1.2 cm. There was no perioperative complication, venous congestion, or arterial insufficiency. Patients were followed clinically for 38.5 months (range, 6 months to 10 years). One patient died from complications of metastatic disease 7 months after plantar flap reconstruction. Two patients underwent sensory testing and gait analysis. The appearance was satisfactory, ambulation returned to normal, and there was protective sensation in every case. In 2 cases, hyperkeratotic tissue was excised in revision procedures. The innervated free medial plantar flap is an attractive and feasible option for coverage of medium-to-large defects of the plantar forefoot in the hands of a skilled microsurgeon. It has a place in our algorithmic approach to forefoot reconstruction.

Repair of high energy injury-induced soft tissue wound of the heel

Objective To investigate the methods and effects of different flaps for repair of high energy injury-induced soft tissue wound of the heel. Methods From January 2002 to June 2012, the patients including 12 males and 9 females aged 18-57 years (mean, 32 years) underwent heel soft tissue defect reconstruction. Causes of injury were traffic injury in 11 case and mechanical injury in 10 cases. Dimension of soft tissue defect ranged from 5 cm×3 cm to 8 cm×6 cm. Soft-tissue defect was repaired with sural neurovascular flaps at the posterolateral heel in 9 cases (Group A), with posterior tibial artery flaps at the posterolateral heel in 5 cases (Group B), and with medial plantar flaps at the loading area of heel in 7 cases (Group C). Sensory recovery and two point discrimination motion of the ankle joint were observed and compared among groups 12 month after operation. Heel pain was observed during weight bearing and joint activity was evaluated using the visual analogue scale (VAS). Results All the flaps survived, except for one with epidermal necrosis over the distal part, which healed after partial changing medication. Duration of follow-up was 12-24 months. There were no differences in the appearance, texture and contour between the flaps and recipient sites. Flaps showed no ulcer in the weight-bearing area and recovered their protective sense. Patients could walk normally after surgery. At postoperative 1 year, sensory recovery rate of the flaps in Groups A, B and C was 0, 20% and 100% respectively (P 0.05). While heel pain existed in weight-bearing exercise.Difference in VAS was significant among the three groups (P 0.05). Conclusion Medial plantar flaps are suitable for tissue defect of 5-8 cm in length but sural neurovascular flaps and posterior tibial artery flaps should be considered for over 8 cm defect in order to elevate survival rate of the flaps and reconstruct limb function. Key words: Foot injuries; Soft tissue injuries; Surgical flaps

Anatomic basis of the distally based venocutaneous flap on the medial plantar artery of the hallux with medial plantar vein and nutrient vessels: a cadaveric dissection.

This study aims to identify a repair procedure for ulcers or defect of the forefoot region. The general distribution and variation of the vascular anatomy of the distally based venocutaneous flap on the medial plantar artery of the hallux with medial plantar vein and nutrient vessels were investigated. This study especially focused on the vascularization of the medial side of the foot and the determination of the contribution of the nutrient vessels of medial plantar vein and medial dorsal cutaneous nerve to flap viability. Experiments were conducted to obtain information for operating procedures and to understand the vascular reliability of the flap. Thirty cadavers were available for this anatomical study after arterial injection. The tuberosity of the fifth metatarsal bone was adopted as the anatomical landmark. Microdissection was conducted under a microscope, and details of the course and distribution of the medial plantar vein and the communication of the medial plantar artery of the hallux with the fascial vascular network surrounding the medial plantar vein were recorded. The flap-raising procedure was performed in a fresh cadaver specimen. The medial plantar vein was incorporated by the medial end of the dorsal pedal vein arch and medial dorsal vein of the hallux around the first metatarsal-medial cuneiform joint. It traveled along the medial margin of the foot and drained into the great saphenous vein at the level of the medial malleolar. The outer diameter of the nerve at the intermalleolar line was 3.2 ± 0.5 mm. These nutrifying arteries to the medial plantar vein were present segmentally and mainly came from the medial plantar artery of the hallux, which traveled forward in the fascia between the abductor hallucis tendon and the first metatarsal bone, emerged into the superficial layer 2.2 ± 0.7 cm proximal to the first metatarsophalangeal joint, and gave off many minute branches. These branches communicated with the fascial vascular network surrounding the medial plantar vein, supplying the fascia and integument of the medial foot. Reliable venocutaneous flap with medial plantar vein and nutrient vessel flaps can be raised based solely on the perforator of the medial plantar artery of the hallux. This flap should be considered as a preferential way to reconstruct soft-tissue defects of the forefoot.

Weight-bearing Plantar Reconstruction Using Medial Plantar Flap Vascularized by Reverse-flow Lateral Plantar Artery: Two Case Reports

Weight-bearing Plantar Reconstruction Using Medial Plantar Flap Vascularized by Reverse-flow Lateral Plantar Artery: Two Case Reports

Évaluation fonctionnelle à long terme des reconstructions complexes du talon par lambeau chez l’enfant

Complex heel injuries in children are rare and their management requires coverage combining resistance and thinness, to allow walking and footwear. The objective of this study was to create a decision-making algorithm for heel defect in children. Children received for heel defect, reconstructed with flap in our plastic surgery unit of Bordeaux with a follow-up greater than 10 years were investigated. Three children operated between 1999 and 2003 were included. A free contralateral reinnervated medial plantar flap, a free latissimus dorsi flap and a lateral supramalleolar flap were performed. Patients were reviewed in consultation to assess quality of reconstruction and functional outcomes. Three scores were used, the Foot Function Index (FFI), the AOFAS Ankle and Hindfoot Scale and the Maryland Foot Score. No growth disorder has been found. Scores greater than 80 for the Maryland Foot Score and AOFAS Ankle and Hindfoot Scale and less than 10 for the FFI were very satisfactory in cases 1 and 3. We found pain and greater functional impairment in the second case. "Like-with-like" reconstruction remains the gold standard, whether in loco-regional or free flap. The fasciocutaneous flaps allow custom reliable coverage with little donor site morbidity. Loco-regional flaps remain easily accessible but donor site sequelae are not negligible.

Limb salvage surgery following resection of a melanoma: Foot and ankle reconstruction using cutaneous flaps.

Melanomas affect the foot and ankle region and are associated with a poor prognosis. The aim of the current study was to evaluate the functional and oncological outcomes of salvage surgery using cutaneous flaps for soft tissue reconstruction of the foot and ankle following the extended resection of a melanoma. A retrospective review was conducted to evaluate patients who presented with foot melanoma and underwent salvage surgery and defect reconstruction using three types of cutaneous flap (group S) or amputation (group A) between January 1999 and December 2010 at the First Hospital of Jilin University (Changchun, China). The postoperative mortality, surgical complications, functional outcomes and oncological outcomes were evaluated. Of the 21 patients, 11 were enrolled into group S and 10 were enrolled into group A. The median follow-up time of the patients was 58 months (range, 6–92 months). In group S, a reverse sural neurocutaneous island flap was used in six patients to perform the foot reconstruction, medial plantar flaps were used in four patients and lateral malleolus flaps were used in one patient. All 11 cutaneous flaps survived and provided satisfactory coverage. Only one cutaneous flap showed partial necrosis and required treatment comprising of debridement and regular changes to the wound dressing. The overall survival rate of patients was 65.0% and patients in the two groups experienced similar oncological outcomes. Salvage surgery with cutaneous flap reconstruction was found to be a reliable option for patients presenting with malignant melanoma of the foot and ankle.

Medial plantar flap to repair defects of palm volar skin.

The methods of repairing defects in fingers, volar skin of the palm and soft tissue were investigated. From 2010 to the present, we examined 12 cases in which medial plantar skin flaps were used to repair defects in the fingers and palm. According to skin and soft tissue defects in the fingers and palm, a flap was designed using the medial plantar artery as the vessel pedicle. The flap was dissected and isolated between the abductor hallucis and flexor digitorum brevis, and transplanted to the hand. We then observed the skin colour, skin texture and tactile sensitivity of the hand, as well as the shape and function of the foot. Follow-up for 3-28 months showed that the flaps survived in all 12 cases, with soft skin, healthy appearance, colour consistent with the palm skin and no pigmentation. The two-point discrimination was 5-7 mm. The donor foot functioned well, and the scar at the donor site was slight and had an aesthetic appearance. The free medial plantar flap is an ideal flap for repairing soft tissue defects in the palm.

Medial pantar venous flap for reconstruction of different locations of digital soft tissue defects

Objective To investigate procedures and clinical effects of medial plantar venous flaps in reconstruction of different sites of finger soft tissue defects.Methods From March 2010 to April 2012,29 cases (31 fingers) of soft tissue defects in different sites were treated with medial plantar venous flaps,including 11 finger tip defects (13 fingers),7 finger back defects (7 fingers),11 finger pulp defects (11 fingers).Size of the defects ranged from 1.2 cm× 1.5 cm to 2.5 cm × 3.5 cm.Size of the flap ranged from 1.5 cm × 2.0 cm to 3.0 cm × 4.0 cm.Donor sites were covered with full thickness skin graft.Results ALL flaps survived,except for one with arterial crisis and two with venous crisis,which were cured after timely vascular exploration and arteriovenous anastomosis.Donor and recipient sites were healed by first intention and skin grafts in donor sites survived.Twenty-four cases (26 fingers) were followed up for 4 to 12 months.Texture and color of the flaps were similar to those of adjacent normal skin,with a satisfactory appearance.Fingerprint and protective sensation were attained for soft tissue defects of the finger tip and pulp after operation.Conclusion Medial plantar venous flap is an ideal surgical option for reconstruction of finger soft tissue defect,for it has advantages of good effect and less damage to donor sites. Key words: Surgical flaps ; Hand ; Soft tissue injuries ; Repair

Repair of palm skin defect using medial plantar flaps with foot-plate cutaneous nerves

Objective To investigate the efficacy of medial plantar flaps with cutaneous nerves on fixing palm skin defects for patients injured while working.Methods All cases with palm skin defects who received medial plantar flaps grafting from June 2003 to January 2013,were analyzed retrospectively.The data included 13 males and 10 females,with the mean age of 36 years old (range,18-61 years old).There were 16 cases with right hand injury and 7 cases with left,whose skin defects ranged from 3.6 cm×2.8 cm to 7.0 cru×5.5 cm.All cases had skin and soft tissue injury while 5 cases with vascular and nerve injury,3 cases with tendon involvement and being exposed,6 cases with open metacarpal fractures.15 patients were treated with emergency surgery within 8 hours after injury,while 8 patients were treated 10 days after debridement surgery.Results Altogether,23 patients who received medial plantar flaps grafting operations,with palm skin defects,were included in this study.All cases were followed up for 3 to 36 months with a average period of 18 month.The grafted flaps range from 4.6 cm×3.8 cm to 8.0 cm×6.5 cm.Among the patients,19 of them recovered excellently with healing by first intention,with 7-14 d healing time,fully-retained hand functions and palm appearance,and 4-8 mm for between two points distinguish test.Flaps survived fairly well in 3 patients because partial necrosis happened at plantar skin graft donor site.After being debrided and dressed,the wound healed at second phase with a healing time of 12-21 d and 5-9 mm for between two points distinguish test.The operated hands could flex and extend functionally in the follow-up period.Only one patient did not recovered from medial plantar flap grafting and the flap did not survive operationally.The patient recovered after another operation with groin skin grafting later.According to Gu Yudong et al' evaluation criteria,such as improved hand function,19 cases were scored as excellent recovery,3 cases as good,and 1 as poor.The excellent rate was 95.7％ (22/23).Conclusion Medial plantar flaps with cutaneous nerves are ideal flaps for palm skin defects restoration,which characterized by the advantages of fixed anatomical position,high survival rate and being good to the functional recovery and palm appearance. Key words: Surgical flaps; Hand; Foot; Skin transplantation

Long-term sensation in the medial plantar flap: a two-centre study.

Reconstruction in the foot and ankle region is challenging. This study aimed to quantify objective sensation return when a sensate medial plantar flap is used for like-for-like reconstruction of foot and ankle defects. Two-point discrimination (2PD) was assessed in flap and normal tissue at a minimum of 1 year post-operatively. A paired T-test assessed for significance. 8 patients were included. Mean 2PD in normal tissue and flap was 29 mm (SD: 11.9) and 33 mm (SD: 9.97) respectively with no statistically significant difference between the two (two-tailed p-value: 0.1898). Mean age was 53.2 years (range: 15-84). There was no statistically significant correlation between age and 2PD in flap tissue (r=0.6, p=0.15). This is the largest case series of its kind. Our results suggest that sensation in medial plantar flaps can return to near normal and demonstrate the important role the medial plantar flap plays in soft tissue reconstruction in this region.

Reconstruction of the great toe using a pedicled medial plantar flap with anterograde venous drainage

Reconstruction of the great toe defect is difficult. The most distal point of the rotation arc of a retrograde-flow medial plantar flap is the plantar side of the proximal phalanx. The purpose of this report was to present a new procedure that extends the rotation arc of this flap. Results of anatomic study and application in two patients were presented. An anatomical study was conducted on 10 freshly frozen cadavers to determine the rotation arc of the medial plantar flap based distally on the lateral plantar vessels. To enable anterograde venous drainage, two accompanying veins of the vascular pedicle were separated and anastomosed to each other. This surgical procedure was implemented in two clinical cases with the great toe defect. The maximum size of the elevated flap was 4 × 7 cm. The status of venous congestion of the flap was determined using the blood glucose measurement index. We confirmed that the rotation arc of the medial plantar flap based distally on the lateral plantar vessels could reach the tip of the great toe, preserving all lateral plantar nerves and plantar metatarsal arteries. In the two cases, the congestion of the flap improved with anterograde venous drainage and the flaps survived completely. A pedicled medial plantar flap with anterograde venous drainage may be a useful alternative option for the reconstruction of relatively large great toe defects.

Long-Term Sensation in the Medial Plantar Flap

INTRODUCTION: The glabrous plantar skin found on the foot and ankle is unique and perfectly adapted to weight bearing, limiting options for like-for-like tissue reconstruction in this region. Soft-tissue reconstruction of foot and ankle defects must be durable1 and provide sensation to prevent future injury.2 A sensate medial plantar fl ap can be raised from the non-weight bearing aspect of the sole and used to repair these defects, providing like-for-like tissue reconstruction whilst limiting donor site morbidity.3 This study aims to quantify sensation return when this versatile fl ap is used to repair foot and ankle defects. METHODS: Two-point discrimination in millimetres (2PD) was assessed in both flap and normal tissue of the contralateral foot in patients who had received a medial plantar flap over a year previously. The mean two-point discrimination in both flap and normal tissue was calculated and a paired T-test was used to assess for a significant difference between flap and normal tissue. RESULTS: 12 patients were eligible. 4 were excluded due to either 2PD in the normal tissue being larger than the flap (3 patients) or because testing was impossible due to hypersensitivity in the flap (1 patient). In the remaining 8, mean 2PD in the contralateral foot was 29mm (SD: 11.9) and mean 2PD in the flap was 33mm (SD: 9.97). No statistically significant difference in 2PD was found between flap and contralateral foot (two tailed p value: 0.1898). Mean age was 53.2 years (range 15-84). There was no statistically significant correlation between age and 2PD on the flap tissue (r=0.6, p=0.15) suggesting no worsening of sensation when this flap is utilised in older age groups. CONCLUSION: To the best of our knowledge this is the first case series to quantify long-term sensation return in medial plantar flaps used to repair foot and ankle defects. Our results suggest that after a year, sensation in the medial plantar flap can return to near normal. This demonstrates the important role the medial plantar flap plays in soft tissue reconstruction in this region.