title: Proximally pedicled medial plantar flap based on superficial venous system alone for venous drainage.
abstract: The proximally pedicled medial plantar flap is well described for coverage of wounds around the ankle and heel. This flap is usually based on the deep venae comitantes for venous drainage, with the superficial veins divided during dissection. Usually any disruption of the deep venous system of the flap would result in abandoning this choice of flap. Venous congestion is a recognised complication of medial plantar flaps. The patient described in this case report had a medial ankle defect with exposed bone, for which a proximally pedicled medial plantar flap was used. As we raised the flap, both venae comitantes of the medial planter artery were found to be disrupted. The flap was raised based on the superficial veins draining into the great saphenous, as the only system for venous drainage, with no evidence of venous congestion. The flap was successfully transposed into the defect and healed with no complications. The proximally pedicled medial plantar flap can safely rely on the superficial venous system alone for drainage. In addition, preserving the superficial veins minimise the risk of venous congestion in this flap. We recommend preservation of superficial venous system when possible.
authors.affiliation: Plastic Surgery Unit, Frenchay Hospital, Bristol BS161LE, UK.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Wright
authors.forename: Bassem M
authors.initials: BM
authors.lastname: Mossaad
authors.forename: Shaheel
authors.initials: S
authors.lastname: Chummun
authors.forename: Umraz
authors.initials: U
authors.lastname: Khan
authors.forename: Thomas W L
authors.initials: TW
authors.lastname: Chapman
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery; D003646:Debridement / Q000379:methods; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D006940:Hyperemia / Q000209:etiology / Q000601:surgery; D008297:Male; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology