Fasciocutaneous
Island Flap Based on the MedialPlantar 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.
