Plantar Skin Defect Reconstruction: A Large Series With a 15-Year Follow-up

Extensive plantar skin defects pose a difficult situation for reconstructive surgeon, but the decision of reconstruction with multiple operations or primary below knee amputation is still open to discussion. Sole of the foot is a specialized tissue; it is important to reconstruct "like for like," that is, a kind of tissue that can endure the wear and tear of daily life and this description fits only "foot skin"; in other words, there is no better substitute for weight-bearing plantar skin, heel and forefoot, except the plantar skin itself. In this article, we present our 25 years' experience of the plantar skin defect surgery with long-term follow-up. Our long-term poor results of foot reconstruction with skin and/or muscle flaps is compared with the durable and ulcer-free midsole flap reconstructions. In a total of 22 patients, 8 latissimus dorsi musculocutaneous flaps, 11 mid sole flaps, and 1 groin flap, 1 reverse sural flap, and 1 free rectus muscle flap were used to resurface the plantar area. The patients underwent mid sole flap were satisfied with their results; however, the patients underwent latissimus dorsi flap were not completely satisfied and 2 of these patients had below knee amputation due to recurrent ulcerations and osteomyelitis. We recommend free vascularized or pedicled plantar skin flaps as the best choice for small, less than two thirds of plantar skin, heel and forefoot defects, and in extensive defects, and for defects of more than two thirds of plantar skin, amputation might be the better solution.