A retrospective study on the medial plantar artery flap for heel pad reconstruction: Institutional experience from India

Purpose The heel pad is a specialized structure designed to resist repetitive mechanical stress during weight-bearing. This study evaluates our institutional outcomes with medial plantar artery flap for such defects and presents a technical modification in flap elevation from medial side to enhance surgical safety and reproducibility. Methods A retrospective review was conducted at the Department of Plastic Surgery, Sri Venkateswara Medical College, Tirupati, from 2022 to 2024. Twenty-four patients undergoing MPA flap reconstruction for heel pad defects were analyzed for demographic profile, etiology, flap dimensions, complications, and outcomes. The flap was raised from the medial side to facilitate early identification of the vascular pedicle and nerve. Results Of the 24 patients (16 males, 8 females; mean age 44.04 ± 11.2 years), trauma accounted for 83.3% (n = 20) of heel defects, while 16.6% (n = 4) were due to chronic diabetic ulcers. Complete flap survival was observed in 21 patients (87.5%), with 3 total losses (12.5%) due to pedicle compression (n = 2) and infection (n = 1). Postoperative complications occurred in 5 patients (23.8%) but were managed successfully. All surviving flaps achieved stable coverage, protective sensation by a mean of 10.8 ± 1.1 weeks, and weight-bearing ambulation by 7.2 ± 0.8 weeks. No donor-site morbidity or recurrence of the wound was noted at 12 months. Conclusions The medial plantar artery flap remains a reliable option for heel pad reconstruction, offering sensate and durable coverage for small to medium-sized defects. The medial-side elevation technique provides clearer anatomical identification and enhances flap safety. Trial Registration Not applicable