It is difficult to reconstruct heel and plantar foot deformities after oncologic excision because these regions require strong, sensitive, and weight-bearing tissue. Because of its thick, glabrous skin and consistent vascular supply, the medial plantar artery flap, also known as the instep flap, provides a great option. It is extracted from the non-weight-bearing medial instep and yields tissue with a texture and toughness that is quite similar to the natural heel pad.
Because of its sensitive nature, which is provided by the medial plantar nerve, it contributes to the preservation of protective feeling that is necessary for both long-term limb safety and gait. This flap guarantees solid covering, encourages early ambulation, and reduces functional compromise, making it a favored reconstructive alternative in cancer patients when broad excision leaves complicated abnormalities. As a consequence, this study described the pertinent anatomy, methodology, and clinical experience in this paper and compile the findings with those found in international literature.
41 patients who had heel and sole defect repair at study institution between January 1, 2007, and December 31, 2018, were the subject of a retrospective investigation. The follow-up period lasted an average of 42.42 months. The medial plantar artery serves as the foundation for the flap.
Medial plantar artery flap repair was performed on forty-one individuals. In 25 individuals, the lesions were found above the heel, and in 16 patients, they were found in the foot's weight-bearing region.
The defect's dimensions varied from 3 x 2 to 10 x 7 cm. Flap loss did not occur in any of the patients. A small percentage of individuals experienced mild wound problems. 8 to 10 weeks following surgery, all patients developed sensate flaps and were able to resume full weight mobilization. No late flap failures occurred.
Overall, one of the greatest reconstructive choices for abnormalities over the weight-bearing portion of the heel is the medial plantar artery. With an excellent color and texture match for heel restoration and a good sensory recovery, satisfactory results were attained. At the donor location, no functional loss was discovered.
Source:
Raja, A., Krishnan, C. K., Krishnamurthy, S. S., Ramachandran, V., Balakrishnan, G., Malik, K., & Narayanaswamy, K. (2025). Medial plantar artery flap for reconstruction of heel and foot defects in malignancy- a retrospective analysis. World Journal of Surgical Oncology, 23(1), 440. https://doi.org/10.1186/s12957-025-04075-8
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