The Use of Local Medial Plantar Artery Flap for Heel Reconstruction: A Systematic Review

Background: Soft tissue reconstruction of the heel represents a daunting challenge for reconstructive surgeons, given the weight-bearing role and anatomical properties of the glabrous skin on the plantar surface. For soft tissue defects in this area, the medial plantar artery (MPA) flap has been described as an optimal reconstructive option. Many studies have reported on the use of the medial plantar artery flap for soft tissue coverage of the heel. There currently exists no systematic review on the topic. Aim: The aim of this article is to review the literature on the use of local medial plantar artery flap for heel reconstruction with a focus on overall flap viability and selected outcomes. Method: The authors performed a systematic literature review using EMBASE, Cochrane Library, Ovid Medicine, MEDLINE, Google Scholar, PubMed database, and grey literature. Studies were identified between 1981 and 2019. Peer-reviewed articles published in the English language were included. Articles were eligible if they contained original clinical outcomes on patients who underwent local medial plantar artery flap for reconstruction of heel defects. Results: A total of 135 unique studies were identified. Eighteen (18) articles were included in the review and analyses, yielding a total of 277 local medial plantar artery flaps for heel coverage. The most common etiology for the reconstructed heel defect was ulcers (45.3%) followed by trauma (35.8%). The overall complete flap survival rate was n=272/277 (98.2%). The incidence of minor flap complication was n=26/277 (9.4%). Most of the flaps maintained protective sensation (n=147/148 [99.3%]), although the protective sensation tended to be inferior to the contralateral normal side. The rate of donor site morbidity was n=14/269 (5.2%). Conclusion: Local medial plantar artery flap for heel defect reconstruction is associated with a very high flap survival rate with very few flap related complications including donor site complications.