The novel use of a hatchet flap to treat a chronic plantar foot ulcer: a case report.

INTRODUCTION: Chronic plantar wounds of the foot are difficult to heal. It is not uncommon for conservative treatment based on debridement and topical dressings to fail. The plantar skin is unique in its resistance to load pressures, such as weight-bearing. Local flaps for immediate definitive coverage are rarely available. This case highlights the novel indication and the successful use of a hatchet flap in the challenging plantar location. CASE PRESENTATION: A 38-year-old male with no history of diabetes presented with a chronic, non-healing 1.5 × 1.5 cm plantar ulcer on a macrodactylic toe, refractory to non-surgical off-loading and serial debridement. A hatchet flap was planned to cover the entirety of the defect in a single-stage procedure. Complete healing was achieved, and the patient regained independent ambulation. No complications were encountered at 6 months of follow-up. CLINICAL DISCUSSION: Although hatchet flaps have been described for scalp, facial, lip, trochanteric, or ischial defects, their use on the plantar weight-bearing surface of the foot has not been reported. This case demonstrates the efficacy of using a hatchet flap for small to moderate chronic wounds of the foot. CONCLUSION: This novel adaptation of the hatchet flap could be added to the surgical armamentarium when facing hard-to-heal wounds of the plantar foot. Its simplicity, reliability, and low donor-site morbidity make it an attractive option for small to moderate plantar defects.