Journal of Foot and Ankle Surgery (Asia Pacific)

Register      Login

VOLUME 10 , ISSUE 1 ( January-March, 2023 ) > List of Articles

ORIGINAL RESEARCH

Medial Plantar Artery Flap for Heel Reconstruction: A 22-year Follow-up

Padam Singh Bhandari, Vaishali Srivastava

Keywords : Foot ulcer, Heel defect, Heel pad, Medial planter artery, Posterior heel defect, Surgical technique

Citation Information : Bhandari PS, Srivastava V. Medial Plantar Artery Flap for Heel Reconstruction: A 22-year Follow-up. J Foot Ankle Surg Asia-Pacific 2023; 10 (1):220-223.

DOI: 10.5005/jp-journals-10040-1257

License: CC BY-NC 4.0

Published Online: 31-12-2022

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Introduction: Heel reconstruction is a surgical challenge because of unique nature of its tissue. The instep flap based on the medial plantar artery neurovascular bundle provides a sensate flap with tissue similar to that of the heel. Materials and methods: The study includes 29 patients with soft tissue defects of the heel who presented between 1998 and 2021. Medial plantar artery flap was done to cover the defect. The patients were followed up for sensations and any ulceration in the flap for a maximum period of 22 years. Results: Twenty-nine patients with soft tissue defects of the heel underwent medial plantar artery flap and were included in the study. Eleven patients continued their follow-up for 22 years. All except one flap survived and did not develop any ulceration in long-term follow-up also. Protective sensations were present in the flap in patients who had normal sensations in the foot before surgery. Results were inferior in patients who had decreased sensations in the sole before surgery such as diabetics and postspinal injury patients. Conclusion: Medial plantar artery flap is a robust and reliable option for heel reconstruction even in long-term follow-up. Clinical significance: Medial plantar artery flap can be safely opted for heel reconstruction and satisfactory results can be expected even after 20 years.


HTML PDF Share
  1. Roblin P, Healy CM. Heel reconstruction with a medial plantar V-Y flap. Plast Reconstr Surg 2007;119(3):927–932. DOI: 10.1097/01.prs.0000242484.54997.9e
  2. Wang M, Xu Y, Wang J, et al. Surgical management of plantar melanoma: a retrospective study in one center. J Foot Ankle Surg 2018;57(4):689–693. DOI: 10.1053/j.jfas.2017.12.004
  3. Reiffel RS, McCarthy JG. Coverage of heel and sole defects: a new subfascial arterialized flap. Plast Reconstr Surg 1980;66(2):250–260. DOI: 10.1097/00006534-198008000-00014
  4. Singh K, Kundu ZS, Singh B, et al. Heel defect reconstruction using local vascularized flaps: results and clinical outcomes in 16 patients. J Foot Ankle Surg (Asia-Pacific) 2018;4(3):16–20. DOI: 10.5005/jp-journals-10040-1083
  5. Saltz R, Hochberg J, Givens KS. Muscle and musclecutaneous flaps of the foot. Clin Plast Surg 1991;18(3):627–638. DOI: 10.1016/S0094-1298(20)30860-9
  6. Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg 1992;89(6):1115–1121. DOI: 10.1097/00006534-199206000-00018
  7. El-Shazly M, Yassin O, Kamal A, et al. Soft tissue defects of the heel: a surgical reconstruction algorithm based on a retrospective cohort study. J Foot Ankle Surg 2008;47(2):145–152. DOI: 10.1053/j.jfas.2007.12.010
  8. Ring A, Kirchhoff P, Goertz O, et al. Reconstruction of soft-tissue defects at the foot and ankle after oncological resection. Front Surg 2016;3:15. DOI: 10.3389/fsurg.2016.00015
  9. Harrison DH, Morgan DG. The instep island flap to resurface plantar defects. Br J Plast Surg 1981;34(3):315–318. DOI: 10.1016/0007-1226(81)90019-9
  10. Schwarz RJ, Negrini JF. Medial plantar artery island flap for heel reconstruction. Ann Plast Surg 2006;57(6):658–661. DOI: 10.1097/01.sap.0000235426.53175.e3
  11. Cormack GC, Lamberty BGH. Medial Plantar Artery. The Arterial Anatomy of Skin Flaps. 2nd ed. New York: Churchill Livingstone; 1994. p. 373–376.
  12. Mourougayan V. Medial plantar artery (instep flap) flap. Ann Plast Surg 2006;56(2):160–163. DOI: 10.1097/01.sap.0000190830.71132.b8
  13. Löfstrand JG, Lin CH. Reconstruction of defects in the weight-bearing plantar area using the innervated free medial plantar (instep) flap. Ann Plast Surg 2018;80(3):245–251. DOI: 10.1097/SAP.0000000000001274
  14. Opoku-Agyeman JL, Allen A, Humenansky K. The use of local medial plantar artery flap for heel reconstruction: a systematic review. Cureus 2020;12(8):e9880. DOI: 10.7759/cureus.9880
  15. Rashid M, Hussain SS, Illahi I. A comparison of two fasciocutaneous flaps in the reconstruction of the weight-bearing heel. J Coll Physicians Surg Pak 2003;13(4):216–218. DOI: 04.2003/jcpsp.216218
  16. Benito-Ruiz J, Yoon T, Guisantes-Pintos E, et al. Reconstruction of soft-tissue defects of the heel with local fasciocutaneous flaps. Ann Plast Surg 2004;52(4):380–384. DOI: 10.1097/01.sap.0000105520.24063.bb
  17. Oh SJ, Moon M, Cha J, et al. Weight-bearing plantar reconstruction using versatile medial plantar sensate flap. J Plast Reconstr Aesthet Surg 2011;64(2):248–254. DOI: 10.1016/j.bjps.2010.04.013
  18. Siddiqi MA, Hafeez K, Cheema TA, et al. The medial plantar artery flap: a series of cases over 14 years. J Foot Ankle Surg 2012;51(6):790–794. DOI: 10.1053/j.jfas.2012.06.003
  19. Macedo JLS, Rosa SC, Filho Neto AVR, et al. The medial plantar flap: a case series. Rev Bras Cir Plást 2017;32(2):256–261. DOI: 10.5935/2177-1235.2017RBCP0041
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.