The plantar marginal septum cutaneous island flap: a new flap in forefoot reconstruction

Soft-tissue reconstruction of the foot very often requires flap coverage to preserve exposed structures such as bone, joint, tendons, and weight-bearing areas. However, forefoot coverage remains a challenge, since the alternatives for flap coverage are very limited. The vascularization of the medial side of the foot was studied in 25 injected limbs. Based on this anatomic knowledge, the plantar marginal septum cutaneous island flap is described. The plantar marginal septum cutaneous island flap is a reversed-flow flap based on the superficial branch of the medial division of the medial plantar artery and its distal anastomosis with the lateral plantar artery, first dorsal metatarsal artery, and lateral branch of the medial plantar artery. The venous drainage is ensured by the accompanying veins. The flap arc of rotation includes the forefoot plantar and dorsal region and the first and second toes. Eight cases have been operated on and are reported.