An Anatomic Study and Clinical Application of Medial Pedis Flap in Asians

In Brief Several investigators have reported their clinical experience with medial pedis flaps for reconstruction of soft tissue defects of the hand and digits. In a cadaveric study in 1997, Jayme and Hamilton described the anatomy of the medial branch of the deep division of the medial plantar artery, which is used in the medial pedis flap. However, they had only a few cases where this flap was used. There have been no such anatomic studies in Korea to date. We found the medial pedis flap to be a reliable option for reconstruction of soft tissue defects of the hand and digits, based on an anatomic study with 10 dissected fresh cadavers (20 cases) and analyzing the clinical outcomes in 17 patients. An anatomic study revealed that there were some racial differences in the diameter and length of the vessels. The diameter of vessels in the Korean population is larger than that in whites. Using a thin, flexible medial pedis flap, which has skin and subcutaneous tissue similar to that of the volar aspect of the hand and digits, we harvested and performed the reconstruction on 17 patients with soft tissue defects of the hands and digits. The vessels used for this flap were the medial branch of the deep division of the medial plantar artery and vena comitantes, or subcutaneous veins. The mean size of the flap was 2.82 cm × 4.15 cm. All flaps were successful without any significant complications. The medial pedis flap possesses several advantages: (1) it is very thin in comparison to other standard free flaps; (2) it has 2 draining venous pathways; (3) it provides a good color and texture match for the hand and fingers; (4) it has a satisfactory recovery of protective sensation. A cadaver study demonstrated that the pedicle vessels of the medial pedis flap are of larger caliber in Koreans than in whites. Seventeen successful free transfers of the flap to soft-tissue defects of the hand and fingers demonstrated satisfactory development of 2-point discrimination, although 8 flaps required subsequent revision.