Quality of innervation in sensate medial plantar flaps for heel reconstruction

Background: Reconstruction of the heel represents a difficult challenge for surgeons, given the demand for thick, durable skin capable of withstanding both pressure and shear. The authors describe the use of a sensate medial plantar flap for heel reconstruction in three patients and document the long-term retention of sensation compared with the contralateral uninjured heel and corresponding donor site. Methods: A medial plantar flap was harvested to include the branch of the medial plantar nerve to the instep to preserve innervation. Sharp pain, light and deep pressure, vibration, cold temperature, and static and dynamic two-point discrimination were examined between 6 months and 1 year after surgery. Results: Sharp pain, vibration, and deep pressure sensation were present equally in the medial plantar flap, contralateral heel, and contralateral instep. Cold perception, light pressure, and static two-point and dynamic two-point discrimination were significantly less in the normal contralateral heel when compared with the heel reconstructed by the innervated flap. There were no significant differences in sensation between the medial plantar flap and the contralateral instep. Conclusions: The medial plantar flap is capable of providing durable, sensate coverage of plantar hindfoot defects with minimal donor-site morbidity. Furthermore, that sensation remains identical to that of the instep donor site and superior to that of the normal heel pad.