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• W2887988305 abstract "Sir: In the article by Scaglioni et al., the authors introduced their experience with using the medial plantar artery perforator flap in the reconstruction of foot defects.1 We applaud the authors for their work. However, the medial plantar artery perforator flap is suitable only for small and medium wounds because the donor site is limited. Besides, the nerve fasciculus can be damaged easily when isolating the medial plantar nerve from the cutaneous nerve bundle of the flap, which could cause sensory disturbance of the anterior part of the foot and the toe.2,3 For large heel defects and irregular wounds, our experience is with use of a waveform free perforator flap (Fig. 1). (See Figure, Supplemental Digital Content 1, which shows the defect on the right heel, https://links.lww.com/PRS/D84.) The most characteristic design of this flap is the waveform design, which can perfectly reconstruct the appearance of the heel and directly close the donor area (Fig. 2). The flap was harvested with the lateral femoral cutaneous nerve. (See Figure, Supplemental Digital Content 2, which shows that the flap was harvested with the lateral femoral cutaneous nerve, https://links.lww.com/PRS/D85.) Then, the defect was covered with the flap and the donor site was closed directly. (See Figure, Supplemental Digital Content 3, which shows the defect covered with the flap, https://links.lww.com/PRS/D86. See Figure, Supplemental Digital Content 4, which shows the donor site was closed directly, https://links.lww.com/PRS/D87.)Fig. 1.: A 51-year-old male patient suffered a skin and soft-tissue defect on his right heel. A waveform of free perforator flap based on the lateral femoral circumflex artery descending branch was designed.Fig. 2.: The flap was shaped to match the heel defect with maximization of use.As we all know, the angle between the ankle and the heel is less than 90 degrees. If the traditional design is adopted, the angle will increase. For a wide wound, the donor site cannot be closed directly. The two triangular valves can turn the scar into a Z shape, to avoid later contracture and cause dysfunction. We agree with the authors’ point of view in the Discussion that the medial plantar artery perforator flap has certain significance.4 Nevertheless, we should not ignore the impact of skin scar on plantar sensation of patients. Although the donor site is not in a weight-bearing area, it is still in a sensitive area. The question is whether to sacrifice the sensation of the donor site in exchange for the shape and texture of the recipient site, not to mention the second donor site. We use the waveform design of free perforator flap based on the lateral femoral circumflex artery descending branch to achieve direct closure of the donor site, and for large defects of the heel. It can reconstruct good shape and carry sensation to restore heel sensation. The patients were followed up for 9 months, with fewer complications and more satisfactory results. (See Figure, Supplemental Digital Content 5, which shows the recipient site at follow-up at 9 months postoperatively, https://links.lww.com/PRS/D88. See Figure, Supplemental Digital Content 6, which shows the donor site at follow-up at 9 months postoperatively, https://links.lww.com/PRS/D89.) The most important thing is that the shape of the heel is close to normal. In addition, with use of this design, the flap can be made into a chimeric flap, especially for the patient with a deep tissue defect or a dead cavity in the heel. If the patient is more obese, it can be combined with a microdissected thinning technique. Flow-through technique can be used to bridge the vessels if the patient has a foot blood flow disorder or vascular injury. In the era of well-developed perforator flap technology when vascular anastomosis is not difficult, a free perforator flap should not be used as the second choice. If we evaluate the ratio of maximum gain to loss from the perspective of patients, the choice would be more individualized and precise.5 Anyway, we agree with the authors’ view that the medial plantar artery perforator flap is a good choice for reconstructing the plantar loading area. DISCLOSURE The authors have no financial interests to disclose in relation to the content of this communication. Ding PanZheng-Bing ZhouJu-Yu TangDepartment of Hand and MicrosurgeryXiangya HospitalCentral South UniversityChangsha, Hunan, People’s Republic of China" @default.
• W2887988305 created "2018-08-22" @default.
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• W2887988305 date "2018-11-01" @default.
• W2887988305 modified "2023-10-14" @default.
• W2887988305 title "Three-Dimensional Reconstruction: The Waveform Design of Free Perforator Flap for the Heel Defect Repair" @default.
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• W2887988305 doi "https://doi.org/10.1097/prs.0000000000004942" @default.
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