Clinical Outcome of Reverse Medial Planter Artery Flap for Soft Tissue Coverage over Planter Aspect of Forefoot Defects: A Case series

Open Access

Abstract

Background: Exposed tendons and bones in forefoot defects require strong, durable coverage. The reverse medial plantar artery flap (RMPAF) has theoretical advantages in forefoot reconstruction, but experience in diverse populations is limited. This study analyzed the clinical outcomes of RMPAF for reconstruction of the forefoot with particular reference to diabetes mellitus. Methods & Materials: A retrospective case series of 22 patients who underwent RMPAF for forefoot reconstruction was conducted. Patient demographics, defect characteristics, operative details, and postoperative outcomes were recorded. Endpoints of interest were flap survival, donor site morbidity, wound healing, and functional recovery. Diabetic and non-diabetic comparisons were made using appropriate statistical tests. Data were analyzed using SPSS v26. Results: The mean age of patients was 52.3±13.6 years, with 72.7% having diabetes mellitus. Diabetic foot ulcers accounted for 54.5% of cases. Overall flap survival was 90.9% with no complete losses. The mean operative time was 95.6±22.3 minutes, with split-thickness skin grafting at the donor site in 100% of cases. Independent walking was possible in 100% of cases. Diabetic patients had longer healing times (26.3±5.2 vs 21.1±4.6 days, p=0.03) and worse functional scores (7.1±1.2 vs 8.4±0.9, p=0.02), but flap survival was comparable between groups.Conclusion: RMPAF provides consistent forefoot reconstruction with good survival and acceptable function. While diabetes impacts healing dynamics and functional recovery, flap survival in diabetic and non-diabetic patients is comparable, validating RMPAF as a viable option for complex forefoot defects in diverse populations.