Medial Plantar Island or Free Flap for Heel Reconstruction

Reconstruction of soft tissue defects in the heel, which is weight bearing area, represents a challenge because this area requires similar tissues to the original lost tissue, durable and sensible skin coverage, minimal donor morbidity and simple operative procedure. The instep region of the plantar surface of the foot presents an ideal tissue reserve for the reconstruction of soft tissue defects in the heel because of a sensate and unique form of skin with thick glabrous plantar skin, shock-absorbing fibrofatty subcutaneous tissue and plantar fascia. A total of 10 patients with soft tissue defects in the heel were operated from April 1995 to October 2001. The medial plantar fasciocutaneous island flap was used in 8 cases and the free flap in 2 cases. The size of flap varied from 3x3 cm to 10x10 cm. Follow-up period ranged from 2.3 years to 8.5 years. All flaps were viable and durable to chronic weight bearing and shearing force. Also, all flaps had enough sensation in normal activities. In conclusion, the medial plantar fasciocutaneous island or free flap can be used satisfactorily for soft tissue coverage in the heel which is weight bearing area.

Clinical Application of Instep Flap / 대한정형외과학회잡지

Soft-tissue defects over the plantar forefoot, plantar heel, Achilles tendon and distal parts of lower leg are often troublesome to cover with a simple graft or local flap due to limited mobility of surrounding skin and poor circulation in these area. Soft-tissue reconstruction in these regions should provide tissue components similar to the original lost tissue, supply durability and minimal protective pressure sensation and result in a donor site that is well tolerated. We analysed 14 cases that were treated with the instep flap due to soft-tissue defects over these regions from JuL 1990 to Oct. 1995. All flaps were viable and successful at follow-up. 1. The age ranged from 5 years to 70 years, and 13 cases were male and 1 case was female. 2. The sites of soft-tissue loss were the plantar forefoot (l case), plantar heel (9 cases), Achilles tendon (3 cases), and distal part of lower leg (1 case). 3. The causes of soft-tissue loss were simple soft-tissue injury (l case), crushing injury of the 1st toe (1 case), post-traumatic infection and necrosis (11 cases) and traction sore (1 case). 4. The associated injury were open distal tibio-fibular fractures (2 cases), medial malleolar fracture of the ankle (1 case), Achilles tendon ruptures (4 cases) and 1st metatarsophalangeal disarticulation (1 case), open calcaneus fracture (1 case) and femur shaft fracture (1 case). 5. The size of flap was from 3 1 cm to 5 10 cm (average 4 5 cm). 6. We could not find post-operative necrosis and infection, non-viability and gait disturbance caused by the instep flap surgery except limitation of the ankle joint in 1 case. In conclusion, this study demonstrates that the instep flap should be considered as another valuable technique in the reconstruction of these regions.