Abstract Background Plantar soft tissue reconstruction is a demanding procedure due to the unique mechanical stress, limited skin mobility, and specialized structure of the plantar surface. This study aims to evaluate the clinical, functional, and aesthetic outcomes of split-thickness skin grafting (STSG) with MatriDerm® compared to the medial plantar flap technique in this challenging context. Methods A retrospective study was conducted from January 2021 to December 2024 including 14 patients with plantar weight-bearing defects (≥2×2 cm²). Seven patients underwent two-stage reconstruction with MatriDerm® and STSG, and seven received medial plantar flap reconstruction. Functional outcomes were evaluated using the Foot Function Index (FFI) and Foot and Ankle Ability Measure (FAAM), while scar quality was assessed with the Patient and Observer Scar Assessment Scale (POSAS). Results POSAS analysis revealed significantly better physician- and patient-reported outcomes for two-stage reconstruction with MatriDerm® and STSG in vascularity, pigmentation, thickness, relief, pliability, surface area, overall impression, pain, pruritus, color difference, and total score (all p < 0.05). FFI and FAAM results showed reduced pain when walking or standing barefoot, improved performance in leisure activities, and better functional outcomes in the MatriDerm® group for walking ≥5 minutes (p < 0.05). Other activities of daily living showed no significant differences. Conclusions The combination of STSG and MatriDerm® represents a less demanding alternative to local reconstructive procedures, such as medial plantar flap reconstruction for plantar soft tissue defects. It offers improved pain reduction, and favorable functional and scar outcomes, making it a practical option in various clinical settings. Level of Evidence: Level IV, therapeutic study.
Nicklas et al. (Fri,) studied this question.