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Combined Medialis Pedis and Medial Plantar Fasciocutaneous Flaps Reconstruct Skin Defects of Multiple Digits with Reducing Times of Flap Division and Function Loss
Hideki Ueyama, MD; Mitsuhiro Okada, MD, PhD; Takuya Uemura, MD, PhD; Mikinori Ikeda, MD; Hiroaki Nakamura, MD, PhD; Osaka City University Graduate School of Medicine
Osaka City university Graduate School of Medicine, Osaka, Japan

Purpose: Skin defects of multiple digits require several times of surgical interventions for the reconstruction. In the case of the coverage by one large skin flap, one surgical intervention is the divisions of the flap into each digit. One large skin flap, moreover, may cause the obstruction of the range of motion of injured digits. The foot is an ideal donor site for digits reconstruction. The combined medialis pedis and medial plantar fasciocutaneous flaps from the foot are nourished by two different branches of the medial plantar artery. The bifurcated branches via one pedicle enable it to cover the skin defects separately, which may reduce the number of times for the divisions of flaps with a simple anastomosis of one artery and one vein. We report a novel idea for reconstruction of skin defects of multiple digits by use of the combined medialis pedis and medial plantar fasciocutaneous flaps.

Methods: Three men patients underwent the combined medialis pedis and medial plantar fasciocutaneous flaps. All patients had palmar or dorsal skin defects of multiple digits with exposures or defects of tendons. Outcomes assessed included the times of number of flap division, complications and the range of motion of injured digits.

Results: Flap survival was 100 percent. One case with palmar skin defects of the right index, long and ring fingers required one surgical intervention of flap division. Other 2 case with skin defects of 2 digits required no flap division. There were no vascular complications. Almost full range of motion of the injured digits was achieved except for one case with extensor tendon reconstruction.

Conclusions: the combined medialis pedis and medial plantar fasciocutaneous flaps have a good indication for skin defects of multiple digits. The bifurcated branches of the medial plantar artery enable us to skip the procedure of flap division and multiple anastomoses. A simple anastomosis can reduce post-operative vascular complication. Good range of motion was achieved by thinness of the combined medialis pedis and medial plantar fasciocutaneous flaps and easy exercise of the range of motion.


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