Weight-bearing plantar reconstruction using versatile medial plantar sensate flap

SummaryThe medial plantar flap serves as an ideal tissue reserve for reconstructing the weight-bearing plantar areas as these areas require a sensate and glabrous skin. Furthermore, the flap provides tissue that is structurally similar to the plantar foot as it is also composed of thick glabrous plantar skin, shock-absorbing fibro-fatty subcutaneous tissue and plantar fascia.During the past 25 years, 20 patients (10 men, 10 women) with skin and soft-tissue defects over the weight-bearing plantar foot were treated. They ranged in age from 20 to 70 years (mean, 31.5 years). The causes of the defects were trauma (n = 14) and malignant tumour (n = 6); the defects were localised at the heel (n = 16) and plantar forefoot (n = 4).The medial plantar flap was transposed to the defects in three different ways: proximally pedicled sensorial island flaps (n = 8), distally pedicled sensate island flaps based on the lateral plantar vessel (n = 3) and neurovascular free flaps (n = 9). Flap size varied from a width of 4–8 cm and a length of 6–12 cm. The mean size of the medial plantar flap was 49.5 cm2 (range, 28–96 cm2).The follow-up period ranged from 6 to 80 months (mean, 19.9 months). Partial flap loss was observed in two proximally pedicled sensorial island flaps and one distally pedicled sensate island flap. Two free flaps restored normal sensation within 5 years of surgery. Minor skin graft loss at the donor site was observed in seven patients. However, no revision or re-grafting was performed. Hyperkeratosis was observed in one case. All patients achieved normal gait within 3 months after surgery and none noticed recurred ulceration. Durable, sensate coverage of the defects was achieved in all patients.We advocate variable sensate medial plantar flaps for the reconstruction of moderate-size defects of the weight-bearing plantar subunits.