Axial medial plantar rotation flap with medial plantar artery or its perforators for reconstructing soft tissue defects in plantar heel: Anatomical observation and report of a clinical series of 11 flaps.

INTRODUCTION: Limited information is available on axial medial plantar rotation (AMPR) flaps. This study aimed to evaluate the clinical outcomes of the AMPR flaps with the medial plantar artery (MPA) or medial plantar arterial perforators (MPAPs) for reconstructing soft tissue defects in the plantar heel and explore their vascular basis.

METHODS: Three perfused amputated specimens were analyzed to identify fasciocutaneous perforators in the intermuscular septum between the abductor hallucis and flexor digitorum brevis muscles. Nine AMPR flaps with the MPAPs and two with the MPA were used for defect reconstruction. Defect sizes ranged from 2 cm × 2 cm to 12 cm × 9 cm. The AMPR flap with the MPAPs was elevated up to the inferior margin of the abductor hallucis muscle.

RESULTS: Five to seven (mean: six) fasciocutaneous perforators were identified in the intermuscular septum. All nine AMPR flaps with the MPAPs survived, whereas two AMPR flaps with the MPA developed necrosis-one with marginal necrosis and the other with partial necrosis.

CONCLUSIONS: Vascular supply from the MPA or from both the flap base and the axial vessels (MPA or multiple MPAPs) forms the vascular basis of the AMPR flap. This flap is effective for reconstructing small, medium, and large plantar heel defects. Its advantages include a simpler and faster surgical procedure, primary donor site closure without the need for skin grafting, an aesthetically favorable outcome, minimal damage to the major vessels in the sole, good donor-recipient site matching, and preserved sensory innervation.