Weight-Bearing Plantar Reconstruction after Resection of Melanoma Using the Medial Plantar Flap

Primary cutaneous melanoma of the foot requires surgical treatment that often lead a defect on weight-bearing areas that must be repaired. The reconstruction of soft tissue defects in the plantar heel remains as a surgical challenge requiring replacement of the lost tissue with another tissue having similar physical characteristics. We describe a series of reconstruction of the plantar heel pad after wide excision of acral melanoma, using the plantar medial artery cutaneous flap, also known as the instep flap. Eleven medial plantar artery flaps performed from 2006 to 2014 were included. The same surgeon at A.C Camargo Cancer Center Hospital (São Paulo, Brazil) performed all the procedures. Of the 11 patients, five were male and 6 were female. They ranged in age from 27 to 58 years. All the flaps were raised as fasciocutaneous pedicled flap based on the medial plantar artery. Flap size varied from 4x4 cm to 6x7 cm. The donor site was covered with a split-thickness skin graft and all patients discharged in the day after. As complications we had partial flap loss in 1 case but no revision or grafting was necessary, hyperkeratosis was observed in 8 case. Although various surgical reconstructive options have been reported, the instep flap represents a good option since the technique does not require special surgical training compared with free flaps, provides tissue to the plantar skin with a similar texture and has less risk of functional donor site morbidity.