Repair of skin defects after excision of plantar tumors

Background: The plantar aspect of the foot is a difficult area for wound coverage and offers restricted/limited possibility for surgical repair. Due to the shearing and ground-reactive forces that the sole of the foot encounters and its unique organizational makeup of plantar skin and fat pad, reconstructive surgical techniques used on other parts of the body cannot be readily adapted to the plantar foot. Objective: The authors present an overview of wound repair after excision of benign or malignant tumor on plantar area. Methods: Retrospective review was done on 27 patients whose benign or malignant tumors on the plantar area were excised. From January 2007 to December 2012, we repaired defects on the plantar foot after simple excision of benign cutaneous tumors or wide excision of malignant melanomas. Patients were reviewed for results and complications. Results: Simple elliptical closure was used for the defects of which the short diameter was below 1.5 cm in 13 patients. Transposition flap was used in 2 patients. The local flap was used when the length to width ratio was smaller than 3 to 1, and the laxity of the skin adjacent to the defect was available. Larger defects of other 12 cases needed to be reconstructed with full thickness skin graft (FTSG) or by secondary intention healing (SIH). The re-epithelialization was shown to be faster in the FTSG group, but the functional and cosmetic results were better in the SIH group. Conclusion: Many defects on the sole were difficult to repair because of the distinct anatomy. In order to treat such large wounds in weight bearing area, both FTSG and SIH are relatively good options.