A comparison between the medial plantar island flap and the free anterolateral thigh perforator flap in repairing soft tissue defects in heels

ZHANG Shuman; WANG Jia; DU Siming

doi:10.3969/j.issn.2097-1753.2025.03.008

Abstract：Objective To compare the therapeutic effects of two repair methods-the medial plantar island flap and free anterolateral thigh perforator flap-against soft tissue defects in the heel.Methods Ninety-five patients with soft tissue defects in the heel were selected as the subjects,who were divided into the control group(40 cases,repaired with the medial plantar island flap)and the study group(55 cases,repaired with the free anterolateral thigh perforator flap).The survival of skin flaps,wound healing and complications,Maryland foot function scores before and after surgery,and levels of satisfaction with the appearance of the Thankappan skin flap one year after surgery were compared between the two groups.Results The postoperative survival rate of skin flaps in the control group was slightly lower than that of the study group,but the difference was of no statistical significance(x2=2.160,P=0.142).Two months after surgery,the healing of heel wounds reached stage Ⅰ in both groups,while incisions at donor sites reached stage Ⅰ linear healing in the study group.There was a dent on the medial side of the foot in the control group,and some patients developed scar hyperplasia at the sites of skin graft.One year later,the color of skin flaps in the two groups was similar to that of the recipient skin,the thickness was moderate without swelling,and the patients resumed normal walking.The Maryland foot function scores in both groups showed a dramatic increase one year after surgery,but there was no significant difference between the two groups(t=1.808,P=0.074).There was also no significant difference in patients' levels of satisfaction with the appearance of the Thankappan skin flap or in the rate of excellence between the two groups(t/x2=1.450,0.082,P=0.150,0.775).Conclusion Both the medial plantar island flap and the free anterolateral thigh perforator flap can effectively repair soft tissue defects in the heel,but there is no significant difference in the survival rate of skin flaps or in therapeutic effect between the two approaches.The free anterolateral thigh perforator flap repair is more conducive to postoperative recovery of foot function.