Anatomic basis of plantar flap design

Area of Science:

• Plastic Surgery
• Foot and Ankle Surgery
• Anatomy

Background:

• Plantar incisions carry risks of subcutaneous nerve injury, impacting flap design.
• Understanding plantar nerve and vascular anatomy is crucial for safe surgical approaches.
• Previous flap designs often required deep dissection, increasing complication risks.

Purpose of the Study:

• To identify safe planes for plantar incisions that minimize nerve injury.
• To guide flap design using knowledge of plantar nerve branch orientation.
• To explore superficial dissection techniques for plantar flaps.

Main Methods:

• Analysis of plantar subcutaneous nerve branch orientation.
• Evaluation of the plantar subcutaneous vascular plexus and its contributions.
• Assessment of blood supply to weight-bearing and non-weight-bearing plantar areas.

Main Results:

• Specific safe planes for plantar incisions exist, minimizing subcutaneous nerve injury.
• An extensive proximal plantar subcutaneous plexus allows superficial flap elevation.
• The plantar skin receives significant dorsal circulation, supporting superficial flaps.

Conclusions:

• Local plantar flaps can be designed with sensation and blood supply using superficial dissection.
• Avoiding deep "subfascial" dissection is feasible and desirable for plantar flap design.
• Subcutaneous sensory plantar flaps offer an improved solution for plantar defects.