Sole Flap Research Articles

Plantar Skin Defect Reconstruction: A Large Series With a 15-Year Follow-up.

Extensive plantar skin defects pose a difficult situation for reconstructive surgeon, but the decision of reconstruction with multiple operations or primary below knee amputation is still open to discussion. Sole of the foot is a specialized tissue; it is important to reconstruct "like for like," that is, a kind of tissue that can endure the wear and tear of daily life and this description fits only "foot skin"; in other words, there is no better substitute for weight-bearing plantar skin, heel and forefoot, except the plantar skin itself. In this article, we present our 25 years' experience of the plantar skin defect surgery with long-term follow-up. Our long-term poor results of foot reconstruction with skin and/or muscle flaps is compared with the durable and ulcer-free midsole flap reconstructions. In a total of 22 patients, 8 latissimus dorsi musculocutaneous flaps, 11 mid sole flaps, and 1 groin flap, 1 reverse sural flap, and 1 free rectus muscle flap were used to resurface the plantar area. The patients underwent mid sole flap were satisfied with their results; however, the patients underwent latissimus dorsi flap were not completely satisfied and 2 of these patients had below knee amputation due to recurrent ulcerations and osteomyelitis. We recommend free vascularized or pedicled plantar skin flaps as the best choice for small, less than two thirds of plantar skin, heel and forefoot defects, and in extensive defects, and for defects of more than two thirds of plantar skin, amputation might be the better solution.

Medial Sural Artery Perforator Flap a Practical Way of Optimizing the Harvesting Procedure

INTRODUCTION: The medial sural artery perforator (MSAP) flap is a versatile reconstructive option. Its’ clinical use has been limited mainly due to the tedious intramuscular preparation of the minute perforators and the inconvenient surgeon’s position during the harvesting. We present an advantageous modification of the standard positioning. Our modification leads to a favorable engorgement of the flap pedicle and perforators, allows harvesting without the need of a tourniquet and also improves the surgical field accessibility for the surgeon. This is an easily applicable and effective way to increase comfort, ease and safety during the flap dissection. MATERIALS AND METHODS: During 2012-2014, we have performed 31 MSAP fasciocutaneous flap reconstructions in 30 patients. Our suggested modification: The patient is positioned supine on the surgical bed, with the knee flexed and the hip joint in abduction. We suggest a modification of the standard positioning, by further introducing several folded surgical towels, as a bulky support, under the calf, so as to push the calf medially as much as possible. The dissection is undertaken firstly in a subfascial plan to identify the perforators, and then intramuscularly in a retrograde fashion to the medial sural artery. No tourniquet is applied in our method. RESULTS: All our flaps were successfully harvested. At least one perforator was inspected and dissected in every case. There were no complications associated with damage of the perforators or the pedicle of the flap during the harvesting. A sole flap failure occurred after the 3rd postoperative day, and was attributed to mechanical pressure of the pedicle. Another MSAP was finally successfully used in that case. CONCLUSION: The MSAP flap is a valuable, advantageous in many cases, reconstructive option in the armamentarium of the plastic surgeon. By applying our suggested modification, the surgeon could harvest with ease and comfort this flap, overcoming its main drawbacks. It is an easily applicable and effective method, which could potentially reduce both operating time and overall complication rates and increase the preference of more surgeons for the MSAP flap in the future, turning it into a workhorse flap in specific reconstructive fields.

Use of the Sole Flap to Convert an Above Knee Amputation to a Below Knee Amputation in Trauma

Use of the Sole Flap to Convert an Above Knee Amputation to a Below Knee Amputation in Trauma

Salvage of a below knee amputation stump with a free sensate total sole flap preserving continuity of the posterior tibial nerve

We illustrate the use of a free sole flap with intact posterior tibial nerve in the coverage of a below knee amputation 6 months after an explosive injury to a 12-year-old child. We discuss the indications for lower leg amputation in children, modalities of reconstruction of the amputation stump and possible reason for the observed change of colour of the flap persisting for 14 days.

Reconstruction of Below-Knee Stump Using the Salvaged Foot Fillet Flap

Three cases of below-knee stump reconstruction, using cross-legged, free sole flap, free foot filleted flap, and island pedicle sole flap, were reported. The variability of the flap size provided satisfactory coverage as needed in all cases. The causes of amputation were acute trauma and chronic osteomyelitis. The contour of the stump, the sensory recovery, the preserved range of motion of the knee joint, and the long-term durability were satisfactory in these patients. Some pitfalls of this procedure and criteria for evaluating the distal extremity soft tissue with respect to their suitability for use are discussed.

The dual leg and sole flap in the replacement of skin defects of the heel

The dual leg and sole flap in the replacement of skin defects of the heel