title: Reconstruction of traumatic plantar foot defects in diabetic patients.
abstract: Plantar reconstruction is often challenging for plastic surgeons because of the peculiar anatomical features of this region. A large variety of reconstructive techniques for the plantar aspect of the foot have been described previously, including skin grafts, local flaps, fasciocutaneous flaps, perforator flaps, cross-limb flaps, and free flaps. This article presents a case of a 64-year-old patient with insulin-dependent diabetes who was involved in a traffic accident that resulted in a large plantar tissue defect (9x4 cm) extending to the base of the toes. After debridement of the wound, a subcutaneous flap was raised from the medial aspect of the lower leg in a sovrafascial plane. The flap was based on a double vascularization given by the great saphenous vein and by the perforator vessels from the posterior tibial artery, located anteriorly and inferiorly to the medial malleolus. The flap showed excellent vitality and long-term result with reduced donor site morbidity. We believe this flap represents a reliable surgical option in superficial plantar defects due to easy harvesting, short operative time, and minimal donor site morbidity. The subcutaneous flap of the distal medial fourth of the leg is a safe technique because of the vascular components of the pedicle. It provides durable coverage, mechanical resistance to pressure and shear stresses and, in selected cases (superficial defects, thin patients), is an interesting option to avoid major free flap procedures.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Milan, Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Vaienti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Palitta
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ravasio
authors.forename: Pietro
authors.initials: P
authors.lastname: Randelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Arrigoni
mesh_terms: D000063:Accidents, Traffic; D017719:Diabetic Foot / Q000150:complications / Q000601:surgery*; D018409:Foot Injuries / Q000150:complications / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D013207:Staphylococcal Skin Infections / Q000209:etiology / Q000601:surgery; D013524:Surgical Flaps