Dr.Tarek Said's Scientific Publications

Fasciocutaneous Island Flap Based on the Medial Plantar Artery for Coverage of Heel Defects

Fathy F. Khodair, M.D., Tarek A. Said, M.D, and Ibrahim G. Khalifa, M.D.

The Department of Surgery, Faculty of Medicine, Cairo University

Egypt. J. Plast. Reconstr. Surg., Vol (23), No (2),1999: 185-191

Soft tissue defects over plantar heel are difficult reconstructive tasks. An island flap localized on the non-weight bearing instep of the foot and based on the medial plantar artery and nerve has been reported to adequately resurface heel defects. The medial plantar nerve can be included in the flap, or the more recent nerve splitting to maintain nerve supply of the digits can be used. 15 patients were operated upon for heel defect coverage using medial plantar artery flap. Successful coverage was achieved in all cases. Minor complications were encountered in the form of superficial sloughing in 1 case and split thickness graft loss on the donor site in another case which needed regrafting. The grafted donor site was well tolerated. Follow-up was done for 6 months and all flaps remained viable with resumption of normal weight bearing using ordinary footwear in 13 cases (86.7%) and special footwear in 2 cases (13.3%). Protective pressure sensation was present in all of the transported flaps while it was preserved over the plantar surface of the metatarsal heads in all cases where nerve was included in the flap. The flap proved to be a good alternative for coverage of heel defects. It has the advantage of transferring similar, sensate tissue to cover the heel, in a single  operative procedure with minimal donor site morbidity. It is available and expendable, with an excellent arc of rotation, reliable circulation and sensibility. Weight bearing is usually restarted after approximately one month.

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