Free Medial Plantar Flap Versus Free Dorsal Myocutaneous Flap for the Reconstruction of Traumatic Foot Sole Defects

SLR - March 2021 - G. Parker Peresko

Level of Evidence: 3

Scientific Literature Review

Reviewed By: G. Parker Peresko, DPM
Residency Program: Swedish Medical Center – Seattle, WA

Podiatric Relevance: In lower extremity trauma, soft tissue coverage is frequently necessary. The authors state that a medial plantar flap from the contralateral lower extremity can be of great assistance in this situation. Unfortunately, in these traumatic scenarios, the contralateral lower extremity can often be greatly compromised. So, to find viable and equivalent alternatives, the authors of this paper compared the medial plantar flap with the latissimus dorsi and scapular flap. 

Methods: Over a period of 14 years (2005 to 2019), 15 patients (consisting of 10 men and five women) in need of coverage for weightbearing plantar foot defects via trauma (the majority being MVA) were retrospectively reviewed. They were treated by either a contralateral medial plantar flap vs a latissimus dorsi or scapular flap. The ages ranged from 4-34 years with an average of 18.07 years in the first group and 13-56 years with an average of 26.55 years in the secondary group. Of note, all surgeries were performed by a primary or secondary reconstruction team post-trauma team intervention. Mean follow up time was 30.13 ± 29.66 months and 64.27 ± 30.06 in the two groups, respectively. 

Results: Defect size for the medial plantar group was 9.73 ± 3.55 x 6.43 ± 2.8 centimeters and 17.14 ± 6.84 x 11.41 ± 4.29 centimeters for the free flap group. No flaps in either group failed and only one, in the dorsal flap group, experienced any form of necrosis. All patients were able to be followed up on clinically. The patients with the medial flap all gained their sensation back, five complained of pain and 10 alluded to inability of normal gait. These results compared with the free flap group where no patients gained sensation back entirely, three patients complained of pain and nine had abnormal gait after their surgery. Additionally, due to the bulkiness from an anatomically unrelated site, seven patients underwent debulking for their free flaps. 

Conclusions: Universally, the medial plantar flap group fared better. The patients had less concerns with scar formation, had a lesser degree of pain, and gained more sensation back at later follow up. Furthermore, most authors look at tactile sensation as the most important factor for flap duration, and this occurred more commonly and at a shorter follow up in the medial plantar flap group. However if one is unable to harvest the medial plantar flap due to concomitant trauma, then an alternative flap is a reasonable choice. In conclusion, if the contralateral foot is viable, the authors recommend the contralateral medial plantar free flap over other free flaps for reconstruction of the plantar foot if possible.