Foot Reconstruction by Reverse Island Medial Plantar Flap Based on the Lateral Plantar Vessel.

Moon, Min Cheol; Oh, Suk Joon; Cha, Jeong Ho; Kim, Yoo Jeong; Koh, Sung Hoon

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Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2010;37(2):137-142.
Published online March 1, 2010.

Foot Reconstruction by Reverse Island Medial Plantar Flap Based on the Lateral Plantar Vessel.

Min Cheol Moon, Suk Joon Oh, Jeong Ho Cha, Yoo Jeong Kim, Sung Hoon Koh

Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Gyeonggi-do, Korea. sjoh@hallym.or.kr

Abstract

PURPOSE
Tumor ablation and traumatic intractable ulceration of the plantar surface of the foot results in skin and soft tissue defects of the weight-bearing sole. Simple skin grafting is not sufficient for reconstruction of the weight-bearing areas. Instead, the island medial plantar flap(instep flap) and distally-based island medial plantar flap was used for proper reconstruction of the weight bearing area. However, there are some disadvantages. In particular, an island medial plantar flap has a short pedicle limiting the mobility of the flap and the distally-based island medial plantar flap is based on a very small vessel. We investigated whether good results could be obtained using a reverse island medial plantar flap based on the lateral plantar vessel as a solution to the above limitations. METHODS: Three patients with malignant melanoma were cared for in our tertiary hospital. The tumors involved the lateral forefoot, the postero-lateral heel, and the medial forefoot area. We designed and harvested the flap from the medial plantar area, dissected the lateral and medial plantar artery and vena comitans, and clamped and cut the vessel 1cm proximal to the branch from the posterior tibial artery and vena comitans. The medial plantar nerve fascicles of these flaps anastomosed to the sural nerve, the 5th interdigital nerve, and the 1st interdigital nerve of each lesion. The donor sites were covered with skin grafting.
RESULTS
The mean age of the 3 subjects was 64.7 years(range, 57-70 years). Histologically, all cases were lentiginous malignant melanomas. The average size of the lesion was 5.3cm2. The average size of the flap was 33.1cm2. The flap color and circulation were intact during the early postoperative period. There was no evidence of flap necrosis, hematomas or infection. All patients had a normal gait after the surgery. Sensory return progressively improved.
CONCLUSION
Use of an island medial plantar flap based on the lateral plantar vessel to the variable weight-bearing sole is a simple but useful procedure for the reconstruction of any difficult lesion of the weight-bearing sole.

Keywords: Island medial plantar flap; Lateral plantar vessel; Foot reconstruction; Sole

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