Plantar Flaps Based on Perforators of the Plantar Metatarsal/Common Digital Arteries

Abstract

Introduction Because of the unique characteristics of its integument, the affirmation “replacing like with like” becomes more than evident in the reconstruction of defects of the ultraspecialized plantar skin. But, the paucity of local resources, and especially in the forefoot, transforms this attempt in a very challenging problem. Many techniques, including skin grafts and various types of flaps were used in the management of defects in the forefoot. We present a new useful flap in the reconstruction of skin defects in the forefoot, based on small perforator vessels originating either from the plantar metatarsal arteries or plantar common digital arteries.

Materials and Methods Starting with June 2011, this flap was performed, as plantar transposition perforator flap, plantar propeller flap, or plantar propeller perforator plus flap, in seven patients with ulcers over the plantar forefoot. During a follow-up of 7 to 17 months (mean, 9.8 months), the local evolution regarding flap integration, pain, relapse, sensitive recovery, donor site, and footwear quality was analyzed.

Results We registered a 100% survival rate of the flaps, with delayed healing in only one case. The gait resumption was possible after 6 weeks in all cases.

Conclusion This new flap, based on small perforator vessels from the plantar metatarsal or common digital arteries, and which provides a good, stable, and sensory recovery, seems to be a promising method in the reconstruction of plantar skin defects over the metatarsal heads.

Keywords

forefoot defects - plantar transposition perforator flaps - plantar propeller perforator flap - plantar propeller perforator plus flap

• References

• 1 Hidalgo DA, Shaw WW. Anatomic basis of plantar flap design. Plast Reconstr Surg 1986; 78 (5) 627-636
• 2 Schwarz R. Reverse medial plantar artery flap. Lepr Rev 2006; 77 (1) 69-75
• 3 Hollenbeck ST, Woo S, Komatsu I, Erdmann D, Zenn MR, Levin LS. Longitudinal outcomes and application of the subunit principle to 165 foot and ankle free tissue transfers. Plast Reconstr Surg 2010; 125 (3) 924-934
• 4 Lu S, Chai Y, Wang C, Wen G. Complex heel reconstruction with a sural fasciomyocutaneous perforator flap. J Reconstr Microsurg 2014; 30 (2) 83-90
• 5 Vaienti L, Palitta G, Ravasio G, Randelli P, Arrigoni P. Reconstruction of traumatic plantar foot defects in diabetic patients. Orthopedics 2010; 33 (5) 360
• 6 Curtin JW. Transposition and Rotation Skin Flaps of the Sole of the Foot. In: Strauch B, Vasconez LO, Hall-Findlay EJ, , eds. Grabbs Encyclopedia of Flaps Vol. III. 2nd ed. Philadelphia, PA: Lippincott-Raven; 1998: 1843-1847
• 7 Emmett AJ. The filleted toe flap. Br J Plast Surg 1976; 29 (1) 19-21
• 8 Dong L, Li F, Jiang J, Zhang G. Techniques for covering soft tissue defects resulting from plantar ulcers in leprosy: Part II—First toe web and dorsal foot flaps. Indian J Lepr 1999; 71 (3) 297-309
• 9 Joshua J, Chakraborthy V. Wound coverage of plantar metatarsal ulcers in leprosy using a toe web flap. Indian J Plast Surg 2005; 38: 123-127
• 10 Colen LB, Replogle SL, Mathes SJ. The V-Y plantar flap for reconstruction of the forefoot. Plast Reconstr Surg 1988; 81 (2) 220-228
• 11 Wang X, Qiao Q, Burd A, Qi K. Reconstruction of distal foot wounds with reverse first dorsal metatarsal artery flap. Burns 2005; 31 (8) 1025-1028
• 12 Bhandari PS, Sobti C. Reverse flow instep island flap. Plast Reconstr Surg 1999; 103 (7) 1986-1989
• 13 Butler CE, Chevray P. Retrograde-flow medial plantar island flap reconstruction of distal forefoot, toe, and webspace defects. Ann Plast Surg 2002; 49 (2) 196-201
• 14 Koshima I, Narushima M, Mihara M , et al. Island medial plantar artery perforator flap for reconstruction of plantar defects. Ann Plast Surg 2007; 59 (5) 558-562
• 15 Cavadas PC. Reversed saphenous neurocutaneous island flap: clinical experience and evolution to the posterior tibial perforator-saphenous subcutaneous flap. Plast Reconstr Surg 2003; 111 (2) 837-839
• 16 Nişanci M, Celiköz B, Duman H. Cross-foot island instep flap: a new use of instep skin flap for management of persistent wounds after complex plantar foot reconstruction. Ann Plast Surg 2001; 47 (2) 127-133
• 17 Koshima I, Urushibara K, Inagawa K, Hamasaki T, Moriguchi T. Free medial plantar perforator flaps for the resurfacing of finger and foot defects. Plast Reconstr Surg 2001; 107 (7) 1753-1758
• 18 Ulusal BG, Lin YT, Ulusal AE, Lin CH, Yen JT. Reconstruction of foot defects with free lateral arm fasciocutaneous flaps: analysis of fifty patients. Microsurgery 2005; 25 (8) 581-588
• 19 Scheufler O, Kalbermatten D, Pierer G. Instep free flap for plantar soft tissue reconstruction: indications and options. Microsurgery 2007; 27 (3) 174-180
• 20 Kim ES, Hwang JH, Kim KS, Lee SY. Plantar reconstruction using the medial sural artery perforator free flap. Ann Plast Surg 2009; 62 (6) 679-684
• 21 Lykoudis EG, Seretis K, Lykissas MG. Free sensate medial plantar flap for contralateral plantar forefoot reconstruction with flap reinnervation using end-to-side neurorrhaphy: a case report and literature review. Microsurgery 2013; 33 (3) 227-231
• 22 Shaw WW, Hidalgo DA. Anatomic basis of plantar flap design: clinical applications. Plast Reconstr Surg 1986; 78 (5) 637-649