Horn-Shaped Perforator Flaps for Plantar.

Objective

To investigate the method and clinical outcomes of employing plantar propeller perforator flaps for the repair of defects in the plantar region.

Methods

This was a retrospective case series of 40 patients (20 males, 20 females; age range 20-75 years) who underwent plantar defect reconstruction using the horn-shaped perforator flap technique between January 2020 and October 2025. Defect etiologies included malignant melanoma (n = 24), melanocytic nevus (n = 3), and refractory wounds (n = 13). Defect sizes ranged from 2 cm × 1.5 cm to 5 cm × 5 cm. The primary outcome was flap survival; secondary outcomes included functional recovery (American Orthopaedic Foot and Ankle Society AOFAS score), sensory recovery (Semmes-Weinstein monofilaments), and time to full weight-bearing.

Results

Complete flap survival was achieved in 38/40 patients (95%). Two patients (5%) experienced minor distal wound dehiscence and necrosis, successfully managed with full-thickness skin grafting and dressing changes without compromising final outcomes. Mean follow-up was 14.2 ± 6.8 months (range 3-24 months). Mean AOFAS score was 91.3 ± 5.6, with 80% achieving excellent functional recovery. Protective sensation was present in 87.1% of the tested patients. Mean time to full weight-bearing was 6.4 ± 1.8 weeks. No local tumor recurrence occurred in melanoma patients during follow-up.

Conclusions

The horn-shaped perforator flap provides a reliable source of homologous glabrous skin for reconstructing small-to-medium-sized plantar defects while avoiding skin grafting at the donor site. Its combined rotation-advancement mechanism, flexible triangular leading-edge strategies, and preservation of multiple perforators contribute to favorable functional and aesthetic outcomes. Prospective comparative studies with standardized plantar-specific outcome measures are warranted.