Question

Write about the vascular basis and operative steps of instep island flap for a heel defect.

Hint:

The instep island flap is a reliable option for heel reconstruction, utilizing the dorsalis pedis artery for vascular supply, with careful planning to ensure flap survival and functional outcomes.

Answer 1

An instep island flap is a type of fasciocutaneous flap that is used to reconstruct heel defects, typically after traumatic injury or surgery. This flap is based on the vascular supply from the dorsalis pedis artery and its branches.
Step 1: Vascular Basis of the Instep Island Flap:
The vascular supply of the instep island flap is provided by the dorsalis pedis artery and its branches, which supply the skin and underlying tissues of the dorsum of the foot and the instep. The vascular pedicle is based on the dorsalis pedis artery, and the flap is elevated from the foot's dorsal surface, ensuring adequate blood supply for the flap's survival.
Step 2: Indications for Instep Island Flap:
The instep island flap is typically indicated for the reconstruction of heel defects, especially those with exposed bone, tendon, or other vital structures. It is also used for soft tissue loss that is difficult to cover with local flaps.
Step 3: Operative Steps for Instep Island Flap:
1. Flap Design: The flap is designed over the dorsum of the foot, incorporating the skin, subcutaneous tissue, and fascia. The dimensions of the flap depend on the size of the defect to be covered. The flap is designed to ensure that it remains based on the dorsalis pedis artery.
2. Incision and Elevation: The flap is elevated by carefully dissecting along its edges, preserving the vascular pedicle. The dorsalis pedis artery is identified and preserved to maintain the blood supply.
3. Transfer of Flap: The flap is then transposed to the heel defect, where it is sutured into place, ensuring that the vascular pedicle remains intact and connected to the recipient site.
4. Closure of Donor Site: The donor site is closed primarily or with a skin graft, depending on the size of the flap and the availability of adjacent tissue for closure.
Step 4: Postoperative Care:
1. Monitoring the Flap: Postoperative monitoring includes checking the flap for signs of adequate perfusion, such as color, warmth, and capillary refill.
2. Wound Care: Proper wound care is essential to prevent infection and ensure that the donor and recipient sites heal properly.
3. Rehabilitation: The patient may need to undergo rehabilitation to regain full function of the foot and ankle following surgery.