Reconstruction of the heel, middle foot sole and plantar forefoot with the medial plantar artery perforator (MPAP) flap: clinical experience with 28 cases

INTRODUCTION: Defects in the weight-bearing region of the foot sole can represent a substantial restriction in quality of life and pose a challenge for reconstructive plastic surgery.The purpose of this article is to report our experience with the use of medial plantar artery perforator (MPAP) flap for reconstruction of defects of the foot sole in 3 different regions: heel, middle foot sole and plantar forefoot. PATIENTS AND METHODS: From January 2003 to May 2016, 28 patients (13 males and 15 females) with an average age of 54 years (range 12 to 84 y.o.) received reconstruction with 28 MPAP flaps.26 flaps were harvested as pedicle perforator flaps and 2 as free perforator flaps. All flaps were raised from the ipsilateral instep area. The defect locations included the heel (20 cases), middle foot sole (4 cases) and forefoot (4 cases).The causes of reconstruction were tumors in 18 patients (64%), decubitus in 8 patients (29%) and trauma in 2 patients (7%). RESULTS: The flap sizes varied from 2.5 × 2.5 cm to 5.5 × 9.5 cm. All of the flaps survived completely after surgery, apart from one. The donor sites were all covered with a split-thickness skin graft. Follow-up observations were conducted for 4 to 12 months, and all patients had good functional recovery with satisfactory cosmetic results. CONCLUSION: The MPAP flap can be considered an optimal method of foot sole reconstruction not only for covering the weight-bearing area of the heel but also for the middle and forefoot plantar region.