Abstract
Purpose
The methods of repairing defects in fingers, volar skin of the palm and soft tissue were investigated.
Methods
From 2010 to the present, we examined 12 cases in which medial plantar skin flaps were used to repair defects in the fingers and palm. According to skin and soft tissue defects in the fingers and palm, a flap was designed using the medial plantar artery as the vessel pedicle. The flap was dissected and isolated between the abductor hallucis and flexor digitorum brevis, and transplanted to the hand. We then observed the skin colour, skin texture and tactile sensitivity of the hand, as well as the shape and function of the foot.
Results
Follow-up for 3–28 months showed that the flaps survived in all 12 cases, with soft skin, healthy appearance, colour consistent with the palm skin and no pigmentation. The two-point discrimination was 5–7 mm. The donor foot functioned well, and the scar at the donor site was slight and had an aesthetic appearance.
Conclusion
The free medial plantar flap is an ideal flap for repairing soft tissue defects in the palm.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Zhang X, Fang X, Shao X, Wen S, Zhu H, Ren C. The use of a third metacarpal base osteoarticular flap for treatment of metacarpophalangeal joint traumatic defects. J Hand Surg Am. 2012;37:1791–805.
Wang B, Zhang X, Jiang W, Ma T, Li H, Wang H. Reconstruction of distally degloved fingers with a cross-finger flap and a composite-free flap from the dorsum of the second toe. J Hand Surg Am. 2012;37:303–9.
Cong HB, Chang SM, Qiao YP, Wang CL, Sui HM, Cong L. One-stage reconstruction of complicated thumb injury with combination of microsurgical transfers. Microsurgery. 2007;27:181–6.
Fan CY, Jiang J, Zeng BF, Jiang PZ, Cai PH, Chung KC. Reconstruction of thumb loss complicated by skin defects in the thumb-index web space by combined transplantation of free tissues. J Hand Surg Am. 2006;31:236–41.
Woo SH, Choi BC, Oh SJ, Seul JH. Classification of the first web space free flap of the foot and its applications in reconstruction of the hand. Plast Reconstr Surg. 1999;103:508–17.
Orbay H, Kerem M, Unlü RE, Esmer AF, Cömert A, Tüccar E, Sensöz O. Vascular anatomy of plantar muscles. Ann Plast Surg. 2007;58:420–6.
Attinger CE, Evans KK, Bulan E, Blume P, Cooper P. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg. 2006;117:261S–93S.
Shanahan RE, Gingrass RP. Medial plantar sensory flap for coverage of heel defects. Plast Reconstr Surg. 1979;64(3):295–8.
Oberlin C, Saffar P. The internal plantar island flap. Anatomic study and surgical applications. Rev Chir Orthop Reparatrice Appar Mot. 1984;70(2):151–4.
Takahashi A, Tamura A, Ishikawa O. Use of a reverse-flow plantar marginal septum cutaneous island flap for repair of a forefoot defect. J Foot Ankle Surg. 2002;41(4):247–50.
Morrison WA, Crabb DM, O’Brien BM, Jenkins A. The instep of the foot fasciocutaneous island and as a free flap for heel defects. Plast Reconstr Surg. 1983;72:56–65.
Yang KM, Xu DC, Shi J, Li ZH. Applied anatomy of free bifolicated flap based on the cutaneous branch of medial plantar superficial artery. Chin J Clin Anat. 2001;2:129–30.
Macchi V, Tiengo C, Porzionato A, Stecco C, Parenti A, Mazzoleni F, Ger R, De Caro R. Correlation between the course of the medial plantar artery and the morphology of the abductor hallucis muscle. Clin Anat. 2005;18:580–8.
Kate M, Dimitrov K. Neurocutaneous metacarpal flaps. Acta Chir Plast. 2008;50:89–92.
Akyürek M, Safak T, Sönmez E, Ozkan O, Keçik A. A new flap design: neral-island flap. Plast Reconstr Surg. 2004;114:1467–77.
Reiffel RS, McCarthy JG. Coverage of heel and sole defects: a new subfascial arterialized flap. Plast Reconstr Surg. 1980;66:250–60.
Kim KS, Kim ES, Kim DY, Lee SY, Cho BH. Resurfacing of a totally degloved hand using thin perforator-based cutaneous free flaps. Ann Plast Surg. 2003;50:77–81.
Kateva M, Dimitrov K. Neurocutaneous metacarpal flaps. Acta Chir Plast. 2008;50:89–92.
Zhu XL, Sun WH, Wang ZT, Hu Y, Liu ZB, Zhu L, Xu QJ, Wu H, Wang DH. Hallux pulp flap combined with plantar metatarsal flap in repairing the pulp defect of fingers. J Shang Dong univ (Health Sci). 2006;44:478–84.
Shaw EG, Tatter SB, Lesser GJ, Ellis TL, Stanton CA, Stieber VW. Current controversies in the radiotherapeutic management of adult low grade glioma. Semin Oncol. 2004;31:653–8.
Rodríguez-Lorenzo AA, Lin CH, Lin CH, Ching WC, Lin YT. Replantation of a degloved hand with added arteriovenous anastomoses: report of two cases. J Hand Surg Am. 2009;34:1864–7.
Doctor AM, Mathew J, Ellur S, Ananthram AA. Three-flap cover for total hand degloving. J Plast Reconstr Aesthet Surg. 2010;63:402–5.
Adani R, Busa R, Tarallo L, Castagnetti C. Update on replantation of degloved skin of the hand. Plast Reconstr Surg. 2004;114:1228–32.
Conflict of interest
Qi-Shun Huang, Xia Wu, Huai-Yuan Zheng, Pan Zhou, Kun Wang, Xue-Wu Zhou, Zhi-Wei Liu and Zhen-Bing Chen state that there are no conflicts of interest.
Ethical standard
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its most recently amended version).
Informed consent
Informed consents obtained from all patients were included in the study.Additional informed consent was obtained from all patients for which identifying information is included in this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Huang, QS., Wu, X., Zheng, HY. et al. Medial plantar flap to repair defects of palm volar skin. Eur J Trauma Emerg Surg 41, 293–297 (2015). https://doi.org/10.1007/s00068-014-0423-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-014-0423-6