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Mokfi MA, Koualla S, Jaadi D, Badaoui Z, Sqalli H, Lamtaouech R, Khales A, Achbouk A, Ababou K. [The value of the medial plantar flap in the repair of loss of soft tissue in the distal quarter of the leg]. ANN CHIR PLAST ESTH 2024; 69:117-123. [PMID: 37230925 DOI: 10.1016/j.anplas.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Soft tissue repair of the distal leg is a challenge for the surgeon. The objective of our work is to evaluate the interest of medial plantar flaps in the repair of soft tissue loss in the distal quarter of the leg, by highlighting the advantages and disadvantages of this technique. METHODS We conducted a retrospective study over 4 years in the Department of Plastic, Reconstructive and Burn Surgery of the Mohammed V Military Teaching Hospital of Rabat, including 8 patients admitted for coverage of a distal quarter of the leg with a medial plantar flap. RESULTS Eight patients were included, 5 men and 3 women with an average age of 45.5 years. All patients received coverage with a medial plantar flap. The functional and aesthetic results were very good with a low complication rate. CONCLUSION The medial plantar flap should no longer be reserved for covering loss of substance of the foot only, but should be integrated into the therapeutic arsenal of reconstruction of the distal quarter of the leg.
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Affiliation(s)
- M A Mokfi
- Service de chirurgie plastique réparatrice et des brûlés, hôpital militaire d'instruction Mohammed V, Rabat, Maroc.
| | - S Koualla
- Service des brûlés et chirurgie réparatrice, CHU de Mohammed VI, Oujda, Maroc
| | - D Jaadi
- Service de chirurgie plastique, CHU d'Ibn Sina, Rabat, Maroc
| | - Z Badaoui
- Service de chirurgie plastique réparatrice et des brûlés, hôpital militaire d'instruction Mohammed V, Rabat, Maroc
| | - H Sqalli
- Service de chirurgie plastique, CHU d'Ibn Sina, Rabat, Maroc
| | - R Lamtaouech
- Service de chirurgie plastique réparatrice et des brûlés, hôpital militaire d'instruction Mohammed V, Rabat, Maroc
| | - A Khales
- Service de chirurgie plastique réparatrice et des brûlés, hôpital militaire d'instruction Mohammed V, Rabat, Maroc
| | - A Achbouk
- Service de chirurgie plastique réparatrice et des brûlés, hôpital militaire d'instruction Mohammed V, Rabat, Maroc
| | - K Ababou
- Service de chirurgie plastique réparatrice et des brûlés, hôpital militaire d'instruction Mohammed V, Rabat, Maroc
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Oon ZS, Kow RY, Ahmad Alwi AA, Ayeop MAS, Low CL, Che Ahmad A. The Role of Medial Plantar Artery Flap in Heel Pad Reconstruction: A Report of Two Cases. Cureus 2023; 15:e41844. [PMID: 37575710 PMCID: PMC10423084 DOI: 10.7759/cureus.41844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
The heel and sole possess unique anatomical characteristics that serve a weight-bearing and shock-absorbing function. The heel is particularly vital, as any defects in this area can lead to gait instability. Reconstructing a heel defect presents challenges, as the donor flap must be durable enough to withstand high force loads while also providing protective sensation. Recently, the medial plantar artery flap has been successfully employed for the reconstruction of defective heel pads. This flap offers glabrous skin capable of weight transmission and intact protective sensation. In this report, we present two cases of heel pad loss secondary to chronic diabetic complications and trauma, respectively, which were treated with medial plantar artery flap reconstruction. Both cases were successfully treated, and they showed a good functional outcome.
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Affiliation(s)
- Zhi Sing Oon
- Department of Orthopedics, Queen Elizabeth Hospital, Kota Kinabalu, MYS
| | - Ren Yi Kow
- Department of Orthopedics, Traumatology, and Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | - Akmal Azim Ahmad Alwi
- Department of Plastic and Reconstructive Surgery, International Islamic University Malaysia, Kuantan, MYS
| | - Mohd Adham Shah Ayeop
- Department of Orthopedics, Traumatology, and Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | - Chooi Leng Low
- Department of Radiology, International Islamic University Malaysia, Kuantan, MYS
| | - Aminudin Che Ahmad
- Department of Orthopedics, Traumatology, and Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
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Zhou JD, Zhang XF, Xu TL, Yang WB, Xu YJ. Super-thin anterolateral thigh flap for reconstruction of the medial plantar artery perforator flap donor site. J Orthop Surg (Hong Kong) 2023; 31:10225536231181706. [PMID: 37268597 DOI: 10.1177/10225536231181706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND The medial plantar artery perforator (MPAP) flap is widely used to reconstruct the weight-bearing area of the foot. Traditionally, its donor site is closed using a skin graft, which is associated with several complications, including walking disability. This study aimed to examine our experience with using a super-thin anterolateral thigh (ALT) flap to reconstruct the MPAP flap donor site. METHODS We examined 10 patients who underwent reconstruction of the MPAP flap donor site using a super-thin ALT flap between August 2019 and March 2021. The vascular pedicle was anastomosed to the proximal end of the medial plantar vessels or the end of the posterior tibial vessels. RESULTS All reconstruction flaps survived and all patients were satisfied with the aesthetic appearance. No blisters, ulcerations, hyperpigmentation, or contractures occurred. All patients gained protective sensation in the super-thin ALT flap. The average visual analog scale score for the aesthetic appearance of the reconstructed foot was 8.5 ± 0.7 (range, 8-10). All patients were able to ambulate without aids and could wear regular shoes. The average revised Foot Function Index score was 26.4 ± 4.1 (range, 22-34). CONCLUSION Reconstruction of the MPAP flap donor site using a super-thin ALT flap is reliable and provides satisfactory functional recovery, aesthetic appearance, and protective sensation while minimizing postoperative morbidity.
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Affiliation(s)
- Jian-Dong Zhou
- Department of Foot and Ankle Surgery, Wuxi 9th People's Hospital, Affiliated to Soochow University, Wuxi, China
| | - Xing-Fei Zhang
- Department of Foot and Ankle Surgery, Wuxi 9th People's Hospital, Affiliated to Soochow University, Wuxi, China
| | - Tong-Long Xu
- Department of Foot and Ankle Surgery, Wuxi 9th People's Hospital, Affiliated to Soochow University, Wuxi, China
| | - Wen-Bo Yang
- Department of Orthopaedic Surgery, Nanjing 1st Hospital, Nanjing, China
| | - Ya-Jun Xu
- Department of Foot and Ankle Surgery, Wuxi 9th People's Hospital, Affiliated to Soochow University, Wuxi, China
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Jung SY, Kim MB, Lee YH. Sensory Reconstruction of a Posterior Heel Defect Using a Proximally Based Sensate Medial Plantar Flap with Retrograde Nerve Cleavage Technique. INT J LOW EXTR WOUND 2021:15347346211055261. [PMID: 34747242 DOI: 10.1177/15347346211055261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Reconstruction of posterior heel defects is important because it requires thick and durable skin that can withstand pressure and shear from shoe and bed contact. Therefore, the sensate flap could be a better option for the defect. This paper reports on the safety of a medial plantar sensory flap for these defects as well as an objective measurement of the sensation of the medial plantar flap and the plantar surface distal to the donor site. Twelve patients had soft-tissue defects in the posterior heel and underwent reconstructive surgery using a proximally based sensate medial plantar sensory flap. Cases of plantar defects involving not posterior heel were excluded. For wider flap coverage, special neurovascular dissection was required. We evaluated levels of sensation quantitatively using Semmes-Weinstein (SW) monofilaments and a two-point discriminator at the final follow-up. All flaps survived without major complications. Postoperative follow-up was 12 to 64 months (mean 26 months). All 12 flaps healed without postoperative complications. There was no significant difference in minimal two-point discrimination and SW evaluator size between the transferred medial plantar flap area and the contralateral heel area or between the plantar area distal to the donor site and the contralateral side. Patients could walk normally and sleep without protective shoes or brace. A proximally based sensate medial plantar flap is a good option for the reconstruction of posterior heel defects. It can restore the characteristics of the posterior heel for shoe wearing and sleeping.
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Affiliation(s)
- Sung Yoon Jung
- Department of Orthopedic Surgery, College of Medicine, 37990Seoul National University, Seoul, Korea
| | - Min Bom Kim
- Department of Orthopedic Surgery, College of Medicine, 37990Seoul National University, Seoul, Korea
| | - Young Ho Lee
- Department of Orthopedic Surgery, College of Medicine, 37990Seoul National University, Seoul, Korea
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Bibbo C. A Novel Limb Salvage Technique of External Fixation Protection of Lower Extremity Plastic Reconstructions with Immediate Postoperative Ambulation (Bibbo Flap and Frame Technique). Clin Podiatr Med Surg 2021; 38:55-71. [PMID: 33220744 DOI: 10.1016/j.cpm.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Non-weight bearing is mandatory after soft tissue reconstructions of the weight-bearing and the high-pressure areas in the lower extremity. The most common method of patient mobilization after surgical reconstruction of chronic foot and ankle wounds has been to place patients non-weight bearing with crutches, walkers, or a wheelchair. Often patients are older, have more complex medical comorbidities, are deconditioned, and simply cannot comply with the prescribed weight-bearing status with these methods, which leads to deconditioning, depression, or noncompliance. Noncompliance quickly leads to failure of the reconstructive effort and the serious threat of limb loss.
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Affiliation(s)
- Christopher Bibbo
- Foot & Ankle Surgery, Plastic Reconstructive & Microsurgery, Orthopaedic Trauma and MSK Infection Services, Rubin Institute for Advanced Orthopaedics, International Center for Limb Lengthening, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
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Liette MD, Ellabban MA, Rodriguez P, Bibbo C, Masadeh S. Medial Plantar Artery Flap for Wound Coverage of the Weight-Bearing Surface of the Heel. Clin Podiatr Med Surg 2020; 37:751-764. [PMID: 32919602 DOI: 10.1016/j.cpm.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Covering soft tissue defects of the heel is particularly challenging because of the highly specialized functional units unique to the plantar fat pad and the shear and compressive forces experienced in this area. The medial plantar artery fasciocutaneous flap provides the unique ability to restore both sensation and the functional units to the plantar heel by taking tissue similar to that which was lost and relocating it from a non-weight-bearing portion of the foot, while maintaining minimal host morbidity. This provides a lasting solution and may prevent future ulcerations from occurring.
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Affiliation(s)
- Michael D Liette
- University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0513, Cincinnati, OH 45276, USA
| | - Mohamed A Ellabban
- Suez Canal University Hospitals and Medical School, Ismailia 41522, Egypt
| | - Pedro Rodriguez
- Plastic and Reconstructive Surgery, OSF Saint Anthony Medical Center, 698 Featherstone Road, Rockford, IL 61107, USA
| | - Christopher Bibbo
- Foot & Ankle, Reconstructive Plastic & Microsurgery & Limb Salvage, Musculoskeletal Infection & Orthopaedic Trauma, Rubin Institute for Advanced Orthopaedics, International Center for Limb Lengthening, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215-5216, USA
| | - Suhail Masadeh
- University of Cincinnati Medical Center, Cincinnati Veteran Affairs Medical Center, 231 Albert Sabin Way, ML 0513, Cincinnati, OH 45276, USA.
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Opoku-Agyeman JL, Allen A, Humenansky K. The Use of Local Medial Plantar Artery Flap for Heel Reconstruction: A Systematic Review. Cureus 2020; 12:e9880. [PMID: 32963919 PMCID: PMC7500739 DOI: 10.7759/cureus.9880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Soft tissue reconstruction of the heel represents a daunting challenge for reconstructive surgeons, given the weight-bearing role and anatomical properties of the glabrous skin on the plantar surface. For soft tissue defects in this area, the medial plantar artery (MPA) flap has been described as an optimal reconstructive option. Many studies have reported on the use of the medial plantar artery flap for soft tissue coverage of the heel. There currently exists no systematic review on the topic. AIM The aim of this article is to review the literature on the use of local medial plantar artery flap for heel reconstruction with a focus on overall flap viability and selected outcomes. METHOD The authors performed a systematic literature review using EMBASE, Cochrane Library, Ovid Medicine, MEDLINE, Google Scholar, PubMed database, and grey literature. Studies were identified between 1981 and 2019. Peer-reviewed articles published in the English language were included. Articles were eligible if they contained original clinical outcomes on patients who underwent local medial plantar artery flap for reconstruction of heel defects. RESULTS A total of 135 unique studies were identified. Eighteen (18) articles were included in the review and analyses, yielding a total of 277 local medial plantar artery flaps for heel coverage. The most common etiology for the reconstructed heel defect was ulcers (45.3%) followed by trauma (35.8%). The overall complete flap survival rate was n=272/277 (98.2%). The incidence of minor flap complication was n=26/277 (9.4%). Most of the flaps maintained protective sensation (n=147/148 [99.3%]), although the protective sensation tended to be inferior to the contralateral normal side. The rate of donor site morbidity was n=14/269 (5.2%). CONCLUSION Local medial plantar artery flap for heel defect reconstruction is associated with a very high flap survival rate with very few flap related complications including donor site complications.
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Affiliation(s)
- Jude L Opoku-Agyeman
- Plastic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Amber Allen
- Foot and Ankle Surgery, Private practice, Philadelphia, USA
| | - Kayla Humenansky
- Plastic and Reconstructive Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
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Systematic reappraisal of the reverse-flow medial plantar flap: From vascular anatomical concepts to surgical applications. J Plast Reconstr Aesthet Surg 2020; 73:421-433. [DOI: 10.1016/j.bjps.2019.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/24/2019] [Accepted: 10/20/2019] [Indexed: 11/17/2022]
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Cang ZQ, Ni XD, Xu Y, Wang M, Wang Q, Yuan SM. Reconstruction of the distal lower leg and foot sole with medial plantar flap: a retrospective study in one center. J Plast Surg Hand Surg 2019; 54:40-46. [PMID: 31581878 DOI: 10.1080/2000656x.2019.1673169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Zheng-Qiang Cang
- Department of Plastic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Dong Ni
- Department of Plastic Surgery, Nanjing School of Clinical Medicine, Bengbu Medical College, Nanjing, China
| | - Yuan Xu
- Department of Plastic Surgery, Jinling Hospital, Nanjing, China
| | - Min Wang
- Department of Plastic Surgery, Jinling Hospital, Nanjing, China
| | - Qian Wang
- Department of Plastic Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Si-Ming Yuan
- Department of Plastic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, China
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Chu W, Liu S, Wang Y, Li J, Liu H. Compressed Fixation Combined with Vacuum-Assisted Closure for Treating Acute Injury of the Heel Fat Pad. Med Sci Monit 2018; 24:9466-9472. [PMID: 30593763 PMCID: PMC6322366 DOI: 10.12659/msm.910440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Treating acute injury of the heel fat pad is different from treating common soft tissue damage. Due to the paucity of literature on the topic, we described our initial experience treating acute injury of the heel fat pad to determine the ideal treatment method. Material/Methods A total of 53 patients with acute injury of the heel fat pad admitted to our hospital were selected for the study and were randomly divided into 2 groups: the compressed fixation combined with vacuum-assisted closure group and the only reimplanted and sewn group. Twenty-seven of the heel fat pads were compressed and fixed using a flat, hard piece of plastic and hollow screws; then, they were covered with a vacuum-assisted closure device. The other 27 were only sewn without tension. The clinical results were evaluated according to the American Orthopedic Foot and Ankle Society hindfoot score and the British Medical Research Council function evaluation criteria Results In the compressed fixation combined with vacuum-assisted closure group, flaps of 12 feet with retrograde avulsion injury survived successfully. Partial flap necrosis occurred in 8 feet. Seven feet underwent repair using the neurocutaneous vascular resupinated island flap. Results were excellent or good for 74% of patients according to the AOFS. However, in the only reimplanted and sewn group, results were excellent or good for 44% of patients according to the AOFS. Conclusions Compressed fixation with vacuum-assisted closure is effective for treating acute injury of the heel fat pad, with high success rates and good utility.
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Affiliation(s)
- Wanzhong Chu
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Shidong Liu
- Department of Orthopedics, Third People's Hospital of Jinan, Jinan, Shandong, China (mainland)
| | - Yeben Wang
- Department of Orthopedics, Third People's Hospital of Jinan, Jinan, Shandong, China (mainland)
| | - Jianmin Li
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Huashui Liu
- Department of Orthopedics, Third People's Hospital of Jinan, Jinan, Shandong, China (mainland)
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Wang M, Xu Y, Wang J, Cui L, Wang J, Hu XB, Jiang HQ, Hong ZJ, Yuan SM. Surgical Management of Plantar Melanoma: A Retrospective Study in One Center. J Foot Ankle Surg 2018; 57:689-693. [PMID: 29631972 DOI: 10.1053/j.jfas.2017.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Indexed: 02/03/2023]
Abstract
Cutaneous melanoma is a highly malignant skin tumor, and in China, the planta pedis is a commonly involved site. The sites of plantar melanomas are a challenge to reconstruct after wide excision. Our experience with surgical management of melanomas was based on the 4 different anatomic subunits of the planta pedis. From January 1, 2002 to December 31, 2016, 35 patients who had had plantar melanoma had undergone surgical treatment in our clinic. The tumor locations were as follows: the toe in 6, the ball of the foot in 5, the arch in 15, and the heel in 9. Surgical management involved extended resection of the tumor, repair of defects with skin grafts or flaps, and inguinal lymphadenectomy. The skin flaps included a residual toe flap, an anterograde or retrograde medial plantar flap, and a retrograde sural neurocutaneous vascular flap. Of the 35 cases of flaps and skin grafts, 33 (94.29%) survived, and the wounds had healed by first intention. After a follow-up period of 6 months to 7 years, 24 patients (68.57%) were free of local and systemic disease and 30 patients (85.71%) were ambulatory using shoes, and all the flaps and skin grafts showed a good appearance. The personalized surgical treatments we used for melanoma in the planta pedis resulted in overall satisfactory outcomes and adequate disease clearance, and allowed the patients to resume normal lives. The function of the foot was maintained or restored to the greatest possible degree, and the patients' quality of life improved postoperatively.
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Affiliation(s)
- Min Wang
- Plastic Surgeon, Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Yuan Xu
- Plastic Surgeon, Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Jin Wang
- Plastic Surgeon, Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Lei Cui
- Plastic Surgeon, Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Jun Wang
- Plastic Surgeon, Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Xin-Bao Hu
- Plastic Surgeon, Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Hui-Qing Jiang
- Professor, Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Zhi-Jian Hong
- Professor, Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Si-Ming Yuan
- Associate Professor, Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Southern Medical University, Nanjing, China.
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Gu JX, Huan AS, Zhang NC, Liu HJ, Xia SC, Regmi S, Yang L. Reconstruction of Heel Soft Tissue Defects Using Medial Plantar Artery Island Pedicle Flap: Clinical Experience and Outcomes Analysis. J Foot Ankle Surg 2017; 56:226-229. [PMID: 28126375 DOI: 10.1053/j.jfas.2016.11.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Indexed: 02/03/2023]
Abstract
We report our clinical experience with 11 cases of heel soft tissue defects treated with a medial plantar artery island pedicle flap. We also evaluated the functional outcomes of reconstruction. We enrolled 11 patients (10 [90.9%] males and 1 [9.1%] female), who received a medial plantar artery island pedicle flap for heel soft tissue defects from August 2010 to July 2014. The cause of the defects included trauma (post-traumatic heel skin necrosis) in 2 (18.2%) patients, infection (calcaneal osteomyelitis with overlying soft tissue infection) in 2 (18.2%) patients, and tumor (stage IA melanoma) in 7 (63.6%) patients. The mean average size of the defect was 3.7 cm × 4.4 cm (range 3.1 cm × 4.0 cm to 4.5 cm × 5.5 cm). The mean follow-up period was 19.6 (range 8 to 35) months, and all flaps survived within that period. The mean static 2-point discrimination was 34.4 (range 29 to 40) mm at the heel and 17.2 mm at the distal sole. The mean visual analog scale score for the aesthetic appearance of the reconstructed heel was 9 (range 8 to 9.5). The average revised Foot Function Index score was 25.8 (range 21 to 37). The medial plantar artery island pedicle flap is a versatile and effective method for reconstructing heel soft tissue defects.
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Affiliation(s)
- Jia-Xiang Gu
- Surgeon, Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, People's Republic of China.
| | - An-Shi Huan
- Postgraduate Student, College of Medicine, Yangzhou University, Yangzhou, People's Republic of China
| | - Nai-Chen Zhang
- Surgeon, Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, People's Republic of China
| | - Hong-Jun Liu
- Surgeon, Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, People's Republic of China
| | - Shi-Cong Xia
- Surgeon, Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, People's Republic of China
| | - Subhash Regmi
- Surgeon, Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, People's Republic of China
| | - Lin Yang
- Surgeon, Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, People's Republic of China
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Ring A, Kirchhoff P, Goertz O, Behr B, Daigeler A, Lehnhardt M, Harati K. Reconstruction of Soft-Tissue Defects at the Foot and Ankle after Oncological Resection. Front Surg 2016; 3:15. [PMID: 27014697 PMCID: PMC4781863 DOI: 10.3389/fsurg.2016.00015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 02/24/2016] [Indexed: 01/12/2023] Open
Abstract
Introduction Solid malignancies at the foot and ankle region are rare and include mainly soft-tissue sarcomas, bone sarcomas, and skin malignancies. Complete surgical resection with clear margins still remains the mainstay of therapy in these malignancies. However, attainment of negative surgical margins in patients with locally advanced tumors of the foot and ankle region may require extensive surgery and could result in loss of extremity function. In these circumstances, plastic surgical techniques can frequently reduce functional impairment and cover soft-tissue defects, particularly in cases of large tumor size or localization adjacent to critical anatomic structures, thereby improving the quality of life for these patients. The aim of this article is to illustrate the various treatment options of plastic surgery in the multimodal therapy of patients with malignant tumors of the foot and ankle region. Materials and methods This article is based on the review of the current literature and the evaluation of the author’s own patient database. Results The local treatment of malignant extremity tumors has undergone major changes over the last few decades. Primary amputations have been increasingly replaced by limb-sparing techniques, preserving extremity function as much as possible. Although defect coverage at the foot and ankle region is demanding due to complex anatomical features and functional requirements, several plastic surgical treatment options can be implemented in the curative treatment of patients with malignant solid tumors in this area. Soft-tissue defects after tumor resection can be covered by a variety of local flaps. If local flaps are not applicable, free flap transfers, such as the anterolateral thigh flap, parascapular flap, or latissimus dorsi flap, can be utilized to cover nearly all kinds of defects in the foot and ankle region. Conclusion Soft-tissue reconstruction in the foot and ankle region is a vital component of limb-sparing surgery. It enables complete resection of locally advanced tumors and subsequent adjuvant radiotherapy. Modern plastic surgical techniques should, therefore, be integrated in the multimodal treatment concept of malignancies in the foot and ankle region.
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Affiliation(s)
- Andrej Ring
- Department for Plastic and Hand Surgery, Burn Center/Sarcoma Reference Center, Ruhr-University Bochum , Bochum , Germany
| | - Pascal Kirchhoff
- Department for Plastic and Hand Surgery, Burn Center/Sarcoma Reference Center, Ruhr-University Bochum , Bochum , Germany
| | - Ole Goertz
- Department for Plastic and Hand Surgery, Burn Center/Sarcoma Reference Center, Ruhr-University Bochum , Bochum , Germany
| | - Bjorn Behr
- Department for Plastic and Hand Surgery, Burn Center/Sarcoma Reference Center, Ruhr-University Bochum , Bochum , Germany
| | - Adrien Daigeler
- Department for Plastic and Hand Surgery, Burn Center/Sarcoma Reference Center, Ruhr-University Bochum , Bochum , Germany
| | - Marcus Lehnhardt
- Department for Plastic and Hand Surgery, Burn Center/Sarcoma Reference Center, Ruhr-University Bochum , Bochum , Germany
| | - Kamran Harati
- Department for Plastic and Hand Surgery, Burn Center/Sarcoma Reference Center, Ruhr-University Bochum , Bochum , Germany
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