Background: The majority of plantar ulcers occur because of diabetic neuropathy, most frequently over the first metatarsal head. Plantar reconstruction is challenging because of the unique anatomical features of this region. The ideal surgical management for plantar wounds is reconstruction with local plantar tissue.
Patients 75 patients with plantar ulceration of the forefoot underwent surgery. Ages ranged from 25 years to 63 years, with a mean age of 49 years. Half the patients (37) had ulcers located medially, 26 in the central and 12 on the lateral aspect of the foot.
Methods: Local transposition flaps were used in all cases. Laterally-based flaps were used for the most common medial ulcers, medial-based flaps used for lateral ulcers, and sometimes both medial and lateral based flaps were used for central ulcers.
Results: 65 (86.7%) patients had primary healing of their wounds with good cosmetic outcome.4 (5.3%) patients had mild flap compromise with delayed healing, 3 (4%) patients experienced a small dehiscence and 3 (4%) patients had ischemia of distal one cm of flap.
Conclusion: In this series of 75 patients, surgical excision and reconstruction of forefoot ulcers with local flaps has proven successful in over 85% of cases.