The medial plantar sensate flap: an effective option for heel reconstruction

Background: The medial plantar sensate (MPS) flap is a reliable and versatile reconstructive option for heel defects. Heel reconstruction presents a unique challenge due to the need for durable, weight-bearing soft tissue that maintains protective sensation and supports normal ambulation. This study aimed to evaluate the outcome of MPA flaps for reconstruction of heel defects, focusing on the rate of complete flap survival and minor flap complications. Methods: This retrospective observational study was conducted in the department of plastic surgery, national institute of burn and plastic surgery, and Green Life hospital. Ltd, Dhaka, Bangladesh, from January 2022 to December 2024. We included 30 patients who had an MPA flap with an evaluation of a soft tissue defect and heel lesion that had been present for several months. Results: The mean age of the participants was 52.0±13.40 years, with a mean BMI of 24.85±5.18 kg/m2. The majority of patients (40%) were over 60 years old, and males accounted for 70% of the study population. The primary indications for flap surgery were ulcers (46.7%), trauma (40.0%), and burns (13.3%). The most common clinical presentation was nonhealing ulcers on the heel (46.7%), followed by post-traumatic soft tissue loss (40%). Ulcers were most commonly located on the posterior heel (57%), with the anterior heel and lateral border being affected in 29% and 14% of cases, respectively. Postoperative complications included infection (10%), delayed wound healing (13.33%), flap necrosis (6.67%), and necrosis of the skin bridge (10%). Despite these complications, the overall flap healing success rate was high, with 90% of patients achieving satisfactory outcomes. Conclusions: This study found that the MPS flap is a reliable and effective option for heel reconstruction. It offers a high flap healing rate with minimal complications. Flap surgery demonstrated a high success rate, with the majority of patients achieving satisfactory healing.