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Strategies for Reconstruction of the Plantar Surface of the Foot: A Systematic Review of the Literature

Crowe, Christopher S., M.D.; Cho, Daniel Y., M.D., Ph.D.; Kneib, Cameron J., B.S.; Morrison, Shane D., M.D., M.S.; Friedrich, Jeffrey B., M.D.; Keys, Kari A., M.D.

Plastic and Reconstructive Surgery: April 2019 - Volume 143 - Issue 4 - p 1223-1244
doi: 10.1097/PRS.0000000000005448
Reconstructive: Lower Extremity
Coding Perspective
Editor's Pick

Background: Reconstruction of the plantar surface of the foot is challenging because of its distinctive anatomy and microarchitecture. Unfortunately, no single coverage option meets the needs of all patients and defects. A comprehensive literature review is presented to better define available reconstructive options for resurfacing the plantar foot.

Methods: A systematic literature search was performed to identify articles relating to reconstruction of the plantar skin and soft tissue. The PubMed, Embase, and Scopus databases were queried for published articles. After the exclusion of duplicate records, 1624 articles were available for review. A total of 280 unique articles were included for analysis, with a total of 2684 individual reconstructions.

Results: Of the articles reviewed, 10 percent described a skin grafting technique, 53 percent described a locoregional flap, 32 percent described free tissue transfer, and 5 percent described multiple reconstructive methods. Isolated heel defects were the most frequently reconstructed subunit of the plantar foot (73 percent). The latissimus dorsi muscle was the most commonly used free flap, whereas the reverse sural artery flap was the most commonly used locoregional flap. Protective sensation was noted in most locoregional and free flap reconstructions, regardless of primary neurotization; however, improved two-point discrimination was noted when neurofasciocutaneous flaps were used. Complication rates varied widely, although rates of flap loss approached those of flaps performed at other anatomical sites.

Conclusions: Numerous methods exist for reconstructing the plantar surface. Proper flap selection should be determined by the size of the defect, the availability of donor tissue, and the surgeon’s experience and comfort with the reconstructive technique.

Coding Perspective for this Article is on Page 1240.

Seattle, Wash.

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine.

Received for publication April 5, 2018; accepted August 17, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. There was no funding obtained for the production of this article.

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Christopher S. Crowe, M.D., Division of Plastic Surgery, University of Washington Department of Surgery, 7CT73.1 Harborview Medicine Center, 325 9th Avenue, Mailstop 359796, Seattle, Wash. 98104,

Copyright © 2019 by the American Society of Plastic Surgeons