The bipedicled medial plantar flap: Vascular enhancement of a reverse flow Y–V medial plantar flap by the inclusion of a metatarsal artery perforator for the reconstruction of a forefoot defect—A case report

The pedicled medial plantar (MP) flap is an optimal solution for defects involving the weight‐bearing areas of the foot. However, venous congestion is a frequently encountered complication, especially with the reverse‐flow variants of the flap, and several strategies have been reported in literature both to prevent and to manage it. In this article, we present the use of a medial plantar flap based distally on the lateral plantar artery with the adjunct of an extra metatarsal perforator from the dorsalis pedis artery as a vascular enhancement to avoid the venous congestion and to improve the overall circulation. This bipedicled flap was successfully advanced to cover a 5 × 3 cm soft‐tissue defect located at the level of the first and second metatarsal heads of the right foot resulting from the excision of a squamous cell carcinoma in an 80‐year‐old male patient with a history of cardiovascular disease. The postoperative course was uneventful. The patient was discharged 7 days after the operation and was able to walk after 6 weeks wearing normal shoes. We believe that preserving plantar metatarsal perforators during the harvesting of an MP flap based distally on the lateral plantar artery may be a precious adjunct as it increases blood supply, especially the venous drainage of the flap.