Medial Plantar Island or Free Flap for Heel Reconstruction

ABSTRACT

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.