The medial plantar sensate flap: an effective option for heel reconstruction
DOI:
https://doi.org/10.18203/2349-2902.isj20250809Keywords:
Nonhealing ulcer, Medial plantar sensate flap, Heel reconstructionAbstract
Background: The medial plantar sensate (MPS) flap is a reliable and versatile reconstructive option for heel defects. Heel reconstruction presents a unique challenge due to the need for durable, weight-bearing soft tissue that maintains protective sensation and supports normal ambulation. This study aimed to evaluate the outcome of MPA flaps for reconstruction of heel defects, focusing on the rate of complete flap survival and minor flap complications.
Methods: This retrospective observational study was conducted in the department of plastic surgery, national institute of burn and plastic surgery, and Green Life hospital. Ltd, Dhaka, Bangladesh, from January 2022 to December 2024. We included 30 patients who had an MPA flap with an evaluation of a soft tissue defect and heel lesion that had been present for several months.
Results: The mean age of the participants was 52.0±13.40 years, with a mean BMI of 24.85±5.18 kg/m2. The majority of patients (40%) were over 60 years old, and males accounted for 70% of the study population. The primary indications for flap surgery were ulcers (46.7%), trauma (40.0%), and burns (13.3%). The most common clinical presentation was nonhealing ulcers on the heel (46.7%), followed by post-traumatic soft tissue loss (40%). Ulcers were most commonly located on the posterior heel (57%), with the anterior heel and lateral border being affected in 29% and 14% of cases, respectively. Postoperative complications included infection (10%), delayed wound healing (13.33%), flap necrosis (6.67%), and necrosis of the skin bridge (10%). Despite these complications, the overall flap healing success rate was high, with 90% of patients achieving satisfactory outcomes.
Conclusions: This study found that the MPS flap is a reliable and effective option for heel reconstruction. It offers a high flap healing rate with minimal complications. Flap surgery demonstrated a high success rate, with the majority of patients achieving satisfactory healing.
Metrics
References
Weinzweig N, Davies BW. Foot and ankle reconstruction using the radial forearm flap: A review of 25 cases. Plast Reconstr Surg. 1998;102(6):1999-2005. DOI: https://doi.org/10.1097/00006534-199811000-00029
Erdemir A, Sirimamilla PA, Halloran JP, van den Bogert AJ. An elaborate data set characterizing the mechanical response of the foot. J Biomech Eng. 2009;131(9):094502. DOI: https://doi.org/10.1115/1.3148474
El-Shazly M, Yassin O, Kamal A, Mohamed M, Giulio G. Soft tissue defects of the heel: A surgical reconstruction algorithm based on a retrospective cohort study. J Foot Ankle Surg. 2008;47(2):145-52. DOI: https://doi.org/10.1053/j.jfas.2007.12.010
Peek A, Giessler GA. Functional total and subtotal heel reconstruction with free composite osteofasciocutaneous groin flaps of the deep circumflex iliac vessels. Ann Plast Surg. 2006;56(6):628-34. DOI: https://doi.org/10.1097/01.sap.0000205768.96705.1e
Thorne CH, Beasley RW, Aston SJ, Bartlett SP, Gurtner GC, Spear SL. Grabb and Smith’s Plastic Surgery. 6th ed. Philadelphia: Lippincott Williams and Wilkins. 1997.
Morrison WA, Crabb DM, O’Brien BM, Jenkins A. The instep of the foot as a fasciocutaneous island and as a free flap for heel defects. Plast Reconstr Surg. 1983;72(1):56-65.
Shanahan RE, Gingrass RP. Medial plantar sensory flap for coverage of heel defects. Plast Reconstr Surg. 1979;64(3):295-8.
Kuran I, Turgut G, Bas L, Ozkan T, Bayri O, Gulgonen A. Comparison between sensitive and non-sensitive free flaps in reconstruction of the heel and plantar area. Plast Reconstr Surg. 2000;105(2):574-80. DOI: https://doi.org/10.1097/00006534-200002000-00015
Shanahan RE, Gingrass RP. Medial plantar sensory flap for coverage of heel defects. Plast Reconstr Surg. 1979;64(3):295-8. DOI: https://doi.org/10.1097/00006534-197909000-00001
Wan DC, Gabbay J, Levi B, Boyd JB, Granzow JW. Quality of innervation in sensate medial plantar flaps for heel reconstruction. Plast Reconstr Surg. 2011;127(2):723-30. DOI: https://doi.org/10.1097/PRS.0b013e3181fed76d
Schwarz RJ, Negrini JF. Medial plantar artery island flap for heel reconstruction. Ann Plast Surg. 2006;57(6):658-61. DOI: https://doi.org/10.1097/01.sap.0000235426.53175.e3
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):216-8.
Mahmoud WH. Foot and ankle reconstruction using the distally based sural artery flap versus the medial plantar flap: a comparative study. J Foot Ankle Surg. 2017;56(3):514-8. DOI: https://doi.org/10.1053/j.jfas.2017.01.019
Miyamoto Y, Ikuta Y, Shigeki S, Yamura M. Current concepts of instep island flap. Ann Plast Surg. 1987;19(2):97-102.
Siddiqi MA, Hafeez K, Cheema TA, Rashid H. The medial plantar artery flap: a series of cases over 14 years. J Foot Ankle Surg. 2012;51(6):790-4. DOI: https://doi.org/10.1053/j.jfas.2012.06.003
Macedo JL, Rosa SC, Filho Neto AV, Silva AA, Amorim AC, Barbosa IM. The medial plantar flap: a case series. Rev Bras Cir Plást. 2017;32(2):256-61. DOI: https://doi.org/10.5935/2177-1235.2017RBCP0041
Khan FH, Beg MSA, Obaid-Ur-Rahman. Medial plantar artery perforator flap: experience with soft-tissue coverage of heel. Plast Reconstr Surg Glob Open. 2018;6(12):1991. DOI: https://doi.org/10.1097/GOX.0000000000001991
Ring A, Kirchhoff P, Goertz O, Behr B, Daigeler A, Lehnhardt M, Harati K. Reconstruction of soft-tissue defects at the foot and ankle after oncological resection. Front Surg. 2016;3:15. DOI: https://doi.org/10.3389/fsurg.2016.00015
Chaudhry ZA, Nisar NA, Effendee S, Yasir AA, Malik A, Khan T. Heel coverage with medial plantar artery flap. Pak J Med Sci. 2008;2:89-92.
Morrison WA, Crabb DM, O’Brien BM, Jenkins A. The instep of the foot as a fasciocutaneous island and as a free flap for heel defects. Plast Reconstr Surg. 1982;72(1):56-63. DOI: https://doi.org/10.1097/00006534-198307000-00013
Gravem PE. Heel ulcer in leprosy treated with fasciocutaneous island flap from the instep of the sole. Scand J Plast Reconstr Hand Surg. 1991;25(2):155-9. DOI: https://doi.org/10.3109/02844319109111276
Benito-Ruiz J, Yoon T, Guisantes-Pintos E, Monner J, Serra-Renom JM. Reconstruction of soft-tissue defects of the heel with local fasciocutaneous flaps. Ann Plast Surg. 2004;52(4):380-84. DOI: https://doi.org/10.1097/01.sap.0000105520.24063.bb
Baker GL, Newton ED, Franklin JD. Fasciocutaneous island flap based on the medial plantar artery: clinical applications for leg, ankle, and forefoot. Plast Reconstr Surg. 1990;85(1):47-58. DOI: https://doi.org/10.1097/00006534-199001000-00009
Amarante J, Schoofs M, Costa H, Reis J, Gongaza R. International dermatosurgery: use of medial plantar-based skin flaps for correction of foot defects. J Dermatol Surg Oncol. 1986;12(7):693-5. DOI: https://doi.org/10.1111/j.1524-4725.1986.tb01973.x
Miyamoto Y, Ikuta Y, Shigeki S, Yamura M. Current concepts of instep island flap. Ann Plast Surg. 1987;19(2):97-102. DOI: https://doi.org/10.1097/00000637-198708000-00001
Downloads
Published
How to Cite
Issue
Section
