Sliding advancement medial plantar artery flap for soft-tissue reconstruction of total heel defects without scar over the weight-bearing area: A case series

Abstract

Reconstructing total heel soft-tissue defects is complex, but the sensate medial plantar artery flap closely mimics heel anatomy. This retrospective observational study describes four cases: two males and two females, aged 3-52 years. Patients presenting with total heel pad defects underwent reconstruction using a sensate medial plantar artery flap without a scar over the weight-bearing area of the heel from 10/2020 to 02/2024. Follow-up ranged from 12 to 48 months. Flap survival, sensory recovery based on the British Medical Research Council (BMRC) scale, and functional recovery based on the American Orthopaedic Foot and Ankle Society (AOFAS) score were studied. Defect size ranged from 4×6 cm to 10×12 cm. Flap size ranged from 5×6 cm to 9×10 cm. All four flaps survived completely, and the donor sites were successfully covered with split-thickness skin grafts. At follow-up from 12 months to 4 years, all patients had good functional recovery with satisfactory aesthetic results. Ultimately, reconstruction of total heel pad defects with this flap without a scar over the weight-bearing area of the heel achieved satisfactory results, with normal function, minimal donor-site morbidity, and a good aesthetic outcome.