Local Flap Reconstruction in Plantar Soft-Tissue Defects of the Foot: Surgical Outcomes from a Prospective Observational Study

Abstract

Background: Plantar soft-tissue defects of the foot resulting from trauma, diabetic foot ulcers, infections, and post-oncological resections present significant reconstructive challenges because of limited local tissue availability, weight-bearing requirements, and the need for durable coverage. Local flaps provide a reliable reconstructive option while preserving function and achieving acceptable aesthetic outcomes.
Aim: To evaluate the effectiveness and outcomes of local flap reconstruction in plantar soft-tissue defects of the foot.
Materials and Methods: A prospective observational study was conducted among 30 patients with plantar soft-tissue defects of the foot managed using local flap reconstruction between December 2024 and December 2025. Flap selection was based on defect size, location, and vascular anatomy. Advancement, rotation, transposition, interpolation, propeller, and intrinsic muscle flaps were used. Patients with extensive composite defects, critical limb ischemia, active osteomyelitis, or peripheral vascular disease were excluded. Outcomes assessed included flap viability, complications, functional recovery, and patient satisfaction.
Results: Complete flap survival was observed in 26 patients (86.7%). Partial flap necrosis occurred in 4 patients (13.3%), and wound infection developed in 3 patients (10.0%). No total flap loss occurred. All complications were managed conservatively with antibiotics, wound care, and debridement when necessary. Most patients achieved stable wound coverage and satisfactorily resumed weight-bearing activities.
Conclusion: Local flaps are a safe, effective, and dependable option for selected plantar soft-tissue defects of the foot. Careful patient selection and meticulous surgical planning yield high flap-survival rates, acceptable complication profiles, and satisfactory functional outcomes.