Reverse-flow Flaps of the Medial Plantar Region: Review of the Literature With Case Report

Many variations of the reverse flap design elevated on the medial plantar region have emerged since its introduction. Our aim was to review the literature to provide a broader understanding of the various iterations of the reversed blood-flow flap raised on the medial plantar region. Second, we wished to appraise the reverse medialis pedis flap by review of the literature and presentation of a case report.

A review of the literature was conducted regarding the reversed blood-flow flap elevated in the medial plantar region. The diverse types of vascular axis and retrograde blood-flow origin of the reverse flap in the medial plantar region were categorized. A clinical case of the reverse medialis pedis flap with step-by-step flap elevation and description of key landmarks are presented.

Our literature review identified 38 publications pertaining to retrograde flow flaps in the medial plantar region. The reverse-flow anatomy derived from these publications was categorized based on vascular axis (pedicle) and retrograde blood-flow origins; Only 5 publications included the reverse medialis pedis flap in their article while 3 papers focused on detailed anatomic study and case series on this flap.

The reverse medial plantar artery flaps come with multiple flap designs depending on which antegrade flow artery is ligated and what anastomotic vascular origin is supplying the reversed blood flow. The reverse medialis pedis flap based on the superficial medial plantar artery with anastomosis to the first plantar metatarsal artery deserves consideration as an option for small defects of the great toe metatarsophalangeal joint.