[Applied anatomy of medial plantar artery combined flaps and repairing heel and adjacent vast soft tissue defects].
OBJECTIVE
To explore an anatomical basis and incising scope for the medial plantar artery combined flaps and its feasibility of repairing heel and adjacent vast soft tissue defects.


METHODS
The origin, branches, course and distribution of the medial plantar artery were studied in 20 legs of adult cadavers. The largest area of healthy adult's medial plantar and medialis pedis scope that could be incised for the combined flap was measured. Ten cases of heel and adjacent vast soft tissue defects were repaired by the combined medial plantar and medialis pedis flaps. Age range 28-60 years old. The areas of flaps were 9 cm x 7 cm - 10 cm x 8 cm. Defects of tendo calcaneus were repaired by the tendon of abductor muscle and plantar fascia in 3 cases with skin grafts on the donor sites.


RESULTS
The medial plantar artery gave off deep branch (diameter: 1.5 mm +/- 0.3 mm) and superficial branch (diameter: 1.0 mm +/- 0.2 mm). The length of media plantar artery deep branch was (8.9 +/- 0.2) cm and gave off 3-5 cutaneous branches. The largest area of combined flap was about 10.4 cm x 9.2 cm - 9.1 cm x 8.2 cm. Ten flaps survived completely. Eight flaps were followed up for 1 month to 1.5 years. The color, texture and appearance of flaps were excellent. The flaps of two-point discrimination were not different with opposite medial region. The affected limb exercised freely and had no ulceration on the flap.


CONCLUSIONS
The combined flap has a reliable blood supply and it can recover good sensation after operation. It is one of ideal flaps to repair heel and adjacent vast soft tissue defects. Its disadvantage is a complicated operation.
Wei
Zai-Rong
ZR
Department of Hand Reconstructive Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi 563003, China. zairongwei@sina.com
Wang
Da-Li
DL
Wang
Yu-Ming
YM
Sun
Guang-Feng
GF
Tang
Xiu-Jun
XJ
Wang
Bo
B
D000328:Adult; D001158:Arteries / Q000033:anatomy & histology* / Q000637:transplantation; D062109:Dermatologic Surgical Procedures; D005260:Female; D005528:Foot / Q000098:blood supply; D006365:Heel / Q000293:injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D012867:Skin / Q000293:injuries; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*