Retrograde Internal Medial Plantar Flap

Abstract

Reconstruction of soft tissue defects of the distal foot and ankle remains challenging due to poor vascularization and limited local tissue availability. This report describes two clinical cases managed with a retrograde internal medial plantar flap for coverage of distal plantar defects. The first patient presented with soft tissue loss of the forefoot following trauma, and the second had a medial plantar defect after tumor excision. In both cases, the medial plantar artery and its venae comitantes were preserved as the vascular pedicle. The flap was elevated and rotated in a retrograde manner to cover the defect, while the donor site was grafted with split-thickness skin. Both flaps survived completely without venous congestion or necrosis. Postoperative recovery was uneventful, and full weight-bearing was achieved within four weeks. The reconstructed areas showed durable, stable, and sensate coverage with minimal donor site morbidity. The retrograde internal medial plantar flap is a reliable and technically straightforward option for reconstruction of distal plantar and ankle defects. It offers well-vascularized and sensitive coverage, providing a functional and aesthetic alternative to free flaps, especially in settings with limited microsurgical resources.