Coverage of heel and sole defects: a new subfascial arterialized flap

Defects of the heel and sole represent difficult reconstructive problems in terms of tissue availability and postoperative morbidity. Although local flaps offer the optimal type of coverage, their application has been restricted to defects of limited size. A study of the plantar skin and fascia, as well as its neurovascular supply, was undertaken in cadavers. Mobility of local flaps is greatest with a narrow pedicle. Dissection deep to the plantar fascia allows the inclusion of the medial or lateral plantar nerve and artery with the flap, thereby allowing considerably mobility while preserving vascularity and sensibility. Several variations of the flap are presented with clinical examples.