[Internal plantar flap. Apropos of 30 cases]

Thirty medial plantar flaps were used in twenty seven patients with large defects in soft tissues of the lower extremity. We performed that flap described in 1981 by Harrison for ankle defects (9 cases) and heel defects (21 cases). The etiology of the defect was a traumatic avulsion in 14 cases, a sole pressure in 10 cases and neurologic ulcer in 6 cases. The surgical procedure was performed in 5 operative sequences: 1--excision of the receptor site 2--disection of the posterior tibial artery and plantaris medialis artery 3--raising of the flap including plantar skin and aponeurosis, respecting the flexor hallucis brevis muscle 4--rotation of the flap and suture on the receiptor site 5--skin graft on the donor site Antibiotics were used according to the per-operative swabs. Full weight bearing was authorized on the 45th day. We observed no failure for heel localization. But in dorsal part of the ankle, we deplore 4 failures (on 9 cases). The rotation for ankle defects was rather important and the risk was squeezing the artery. We used 3 times the medial plantar flap as a cross foot. We observed 1 failure; the possibility of long pedicled flap (parallel legs), the innocuity for the donor site, the quality of the transferred skin are arguments for using that flap in a cross leg of rather small dimension. We successfully performed two more cross legs using this technique since that study. We think that the medial plantar flap is the best technique for heel reconstruction. The quality of the skin transferred is very able to make a secondary thickening reproducing exactly the consistence of the heel. The fiability of that flap is very high for the heel localisations (no failures on 21 cases).