Free advancement ipsilateral medial plantar artery flap to encompass the entire plantar aspect of the foot - a case report and comprehensive review.

Sarcomas affecting weight-bearing areas of the foot are a rare disease and represent a reconstructive challenge. The medial plantar artery (MPA) flap offers an optimal "like with like" reconstructive option for the sole. However, it has certain limitations such as the limited reach of the vascular pedicle, vascular impairment associated with retrograde flow flap or the morbidity of using contralateral foot as a free flap donor site. We present a case of a 30-year-old male with left sole forefoot defect after sarcoma excision. Because of the previous excision surgery along with the wish to avoid morbidity in the contralateral foot, reverse flow MPA flap and contralateral free MPA flap were ruled out. Reconstruction using an ipsilateral anterograde flow MPA flap with pedicle extension using a grater saphenous vein loop to advance the flap and reach the defect was proposed. After 9 months of reconstruction, the patient achieved full weight-bearing and ambulated normally without any complications. We propose this method of elongating the pedicle of the MPA flap as an optimal procedure, capable of encompassing mid-size defects in the entire sole of the foot. This approach reduces the morbidity associated with using the contralateral foot and avoids sacrificing other vascular axis in the affected foot for use as a recipient vessel. Although complications of the harvesting site are known, we believe that MPA flap is still the best option for reconstructing the weight bearing area.