Heel reconstruction with a medial plantar V-Y flap.
BACKGROUND
Full-thickness defects to the plantar surface of the foot present a challenge to the reconstructive surgeon. Skin grafts and a variety of flap procedures have been described to resurface this site, but not all achieve a return to normal foot function. For the plantar surface of the heel, the previously described medial plantar flap can produce successful results. However, this method leaves a donor site, which requires skin grafting. This is a report of a modification of the medial plantar flap into a V-Y configuration that allows direct closure of the donor site.


METHODS
Three defects of the plantar surface of the heel were resurfaced: case 1, a spina bifida patient with a 45-mm-wide debrided pressure sore; and cases 2 and 3, patients with defects resulting from wide excisions of melanomas that were 47 and 57 mm wide, respectively. Patients in cases 2 and 3 were reviewed at 1 year for mobility, gait, and sensation in the flap.


RESULTS
The patients in cases 2 and 3 were able to attain full, unrestricted mobility and objectively near-normal sensation of the resurfaced skin. In the patient in case 1, a problematic pressure sore was healed after an intermediate period of wound dehiscence, with a robust, bulky flap.


CONCLUSIONS
This modified flap retains the advantages of the traditional medial plantar flap while minimizing its donor-site problems. It has permitted satisfactory long-term functional results, optimizing restoration of foot function, and is a useful option that can be considered for resurfacing the problematic plantar surface of the heel.
Roblin
Paul
P
Department of Plastic Surgery, St. Thomas' Hospital, London, UK. paulroblin@doctors.org.uk
Healy
Ciaran M J
CM
D000368:Aged; D005260:Female; D005534:Foot Diseases / Q000601:surgery; D006365:Heel / Q000601:surgery*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000601:surgery; D008875:Middle Aged; D003668:Pressure Ulcer / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012878:Skin Neoplasms / Q000601:surgery; D013524:Surgical Flaps