Effects of medial plantar artery perforator flap transplantation in the reconstruction of palmar scar contracture

Yu Yuzhi; Dong Shunan; Yu Tian; Jiang Jiyong; Li Xiaogen

doi:10.3760/cma.j.cn501225-20240726-00281

Volume 41 Issue 7

Jul. 2025

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Yu Yuzhi, Dong Shunan, Yu Tian, et al. Effects of medial plantar artery perforator flap transplantation in the reconstruction of palmar scar contracture[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2025, 41(7): 673-679. Doi: 10.3760/cma.j.cn501225-20240726-00281

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Effects of medial plantar artery perforator flap transplantation in the reconstruction of palmar scar contracture

doi: 10.3760/cma.j.cn501225-20240726-00281

1.
Department of Hand Surgery, Guangzhou Peace Orthopedic Hospital, Guangzhou 510220, China
2.
Department of Upper Limb Repair and Reconstruction Surgery, Beijing Jishuitan Hospital Guizhou Branch, Guiyang 550014, China

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Corresponding author: Dong Shunan, Email: dong18585115275@163.com
Received Date: 2024-07-26

Abstract

Abstract

Objective To investigate the effects of medial plantar artery perforator flap in the reconstruction of palmar scar contracture. Methods This study was a retrospective observational study. From January 2016 to January 2023, 15 patients with palmar scar contracture who met the inclusion criteria were admitted to Guangzhou Peace Orthopedic Hospital, including 12 males and 3 females, aged 15 to 50 years. Before surgery, the Michigan Hand Outcomes Questionnaire (MHQ) scores for the affected hands ranged from 58 to 77, and the total active motion for the affected hands ranged from 190° to 220°. The skin and soft tissue defect area after scar excision on the palmar side of the affected hands was 5.2 cm×3.2 cm to 7.2 cm×6.0 cm. According to the location and area of the wounds, the defects were repaired using either medial plantar artery superficial perforator flaps or combined flaps of the cutaneous perforator of superficial branch of medial plantar artery and medial branch of medial plantar artery deep branch. The area of the harvested flaps was 5.5 cm×3.5 cm to 7.5 cm×6.8 cm. The donor site wounds on the feet were repaired using superficial circumflex iliac artery perforator flaps. Postoperatively, the survivals of the medial plantar artery perforator flaps and superficial circumflex iliac artery perforator flaps were observed. After survival of the flaps, patients were guided for rehabilitation exercises for the affected hands. Regular outpatient follow-up was conducted after surgery to observe the appearance, color, and texture of the medial plantar artery perforator flaps, and the recovery of foot function. At the final follow-up, the two-point discrimination distance of the medial plantar artery perforator flap was measured, the function of the affected hands was evaluated using the trial criteria for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association and the MHQ. Results Postoperatively, two patients experienced vascular crisis of the medial plantar artery perforator flaps, while the flaps survived after emergency exploration; the medial plantar artery perforator flaps and superficial circumflex iliac artery perforator flaps survived in other patients. Follow-up for 6 to 18 months postoperatively showed that the medial plantar artery perforator flaps had no bulky appearance, similar color and texture to the surrounding skin, and the foot functions such as running and jumping were not affected. At the final follow-up, the two-point discrimination distance of the medial plantar artery perforator flap ranged from 7 to 10 mm, with an average of 8 mm; the affected hand function was rated as excellent in 12 cases and good in 3 cases; the MHQ scores of the affected hand function ranged from 81 to 95, and the patients were satisfied with the postoperative appearance, pain relief, and functional recovery of the affected hand. Conclusions The medial plantar artery perforator flap is used for the reconstruction of palmar scar contracture. The flap is easy to harvest, and has a high survival rate, resulting in good postoperative recovery of the flap sensation and function of the affected hand, and minimal donor site injury in the foot. It is therefore worthy of clinical promotion.
- Hand,
- Cicatrix,
- Perforator flap,
- Medial plantar artery,
- Hand surgery

(1) It was confirmed that the perforating vessels of medial plantar artery had a consistent course and were located superficially. The flap could be flexibly designed according to the wound requirements during surgery, and the flap harvesting would not damage the trunk of the medial plantar artery nor affect the blood supply of the foot. Besides, the flap donor site was concealed and located in the non-weight-bearing area of the foot, therefore not affecting the foot function after flap harvesting.
(2) It was confirmed that the medial plantar artery perforator flap had a texture similar to that of the palmar skin, and its transplantation to reconstruct the palmar scar contracture resulted in good recovery of the appearance, sensation, and function of the affected hand, with patients being highly satisfied after surgery.

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References(41)

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