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A new method of excision of painful plantar forefoot lesions using a rotation advancement flap.

A new method of excision of painful plantar lesions in the forefoot was studied in 13 feet (12 patients). Etiology of the lesions was variable, including traumatic and iatrogenic scars. Localized transfer of partially undermined tissue is used to fill a triangular defect created by excising the lesions. The flap is advanced/rotated into place, without gapping or tension. Full sensation is maintained and because of the significant vascular contribution by the proximal plantar subcutaneous plexus, there is little chance of vascular compromise. Problematic scars occurred in only three feet (two patients). Complications included inclusion cysts in two cases, one parakeratotic nodule and an incidental occurrence of verruca in one case. Follow-up average was 25 months. This procedure provides an alternative method for resolving patients' painful plantar lesions.