Arch Hand Microsurg.  2021 Mar;26(1):43-49. 10.12790/ahm.20.0046.

Subunit Principle: Key Element for Plantar Reconstruction with Free Sensate Flaps

• Sanchez BYA
• Gallardo DDL
• Espinoza JAG
• Soto DF

• KMID: 2513205
• DOI: http://doi.org/10.12790/ahm.20.0046

Abstract

Purpose
Plantar wounds represent a frequent practice of the plastic and reconstructive surgeon. The uniqueness and high complexity of the microarchitecture and biomechanics of the plantar region explain the complex challenge of its reconstruction. With the advances in microsurgery, including the plantar subunit principle, both applied in the restoration of plantar defects through the use of sensorineural free flaps have allowed an optimal reconstruction.
Methods
A descriptive, retrospective study was carried out in a period of time established between January 2016 and January 2019, obtaining a total of 18 patients with plantar defects, reconstructed using sensory free flaps. Tissue stability, recovery of protective sensitivity, early ambulation, and correct use of footwear were evaluated.
Results
The most frequent etiology was secondary to oncological resections due to melanoma (n = 12, 66.7%), followed by gunshot wounds (n = 4, 22.2%). Subunit 3 was the most frequently involved in 38.9% (n = 7). In the 88.8% of the cases, was used an anterolateral thigh flap (n = 16) and the lateral antebrachial flap in 22.2% (n = 2). The free flap survival rate was 100%. An average of seven points was obtained at 6 months based on the Semmes-Weinstein test. The mean for the return to their daily activities was 2.5 months. The patients of 94.4% (n = 17) recovered ambulation and could footwear.
Conclusion
The reconstruction of plantar defects must have a systematic approached, taking the subunit principle as a central point. The treatment of plantar defects with sensorineural free flaps represent an unprecedented option for optimal reconstruction.

Keyword

Plantar reconstruction; Sensate flaps; Microsurgery; Melanoma

Figure

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  Fig. 1. Hollenbeck’s plantar subunits.

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  Fig. 2. Incidence of plantar subunit affected.

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  Fig. 3. (A) Plantar melanoma in the heel region. (B) Anterolateral thigh flap reconstruction and mediate result. (C) Result at 6-month postoperative follow-up.

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  Fig. 4. (A) Cutaneous defect after subunit 2 melanoma resection. (B) Free radial flap reconstruction with immediate postoperative result. (C) Six-month postoperative follow-up.

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