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J Reconstr Microsurg 2014; 30(02): 083-090
DOI: 10.1055/s-0033-1357270
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Complex Heel Reconstruction with a Sural Fasciomyocutaneous Perforator Flap

Shengdi Lu
1   Department of Repair and Reconstruction, Shanghai 6th People's Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China
,
Yimin Chai
1   Department of Repair and Reconstruction, Shanghai 6th People's Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China
,
Chunyang Wang
1   Department of Repair and Reconstruction, Shanghai 6th People's Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China
,
Gen Wen
1   Department of Repair and Reconstruction, Shanghai 6th People's Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China
› Author Affiliations
Further Information

Publication History

27 June 2013

31 July 2013

Publication Date:
25 October 2013 (online)

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Abstract

Reconstruction of weight-bearing surfaces at the foot and ankle is controversial. Free tissue transfer and local fasciocutaneous perforator flaps are preferred for plantar reconstruction, but high rates of flap breakdown and ulceration have caused unsatisfactory functional outcomes. We present a modified “sural fasciomyocutaneous perforator flap” and its functional outcome. Between January 2007 and September 2010, 19 patients were treated for soft-tissue defects in the weight-bearing area with sural fasciomyocutaneous perforator flaps. The gastrocnemius, preserved in the base of the flap, was applied as padding under the calcaneus. In follow-up from 9 to 25 months (mean 13.8 months), each patient's pain score, defect size, ulcer formation, protective sensation recovery, and normal footwear were analyzed. The majority of the flaps survived with satisfactory aesthetic and functional results. One case of partial flap loss and one case of delayed ulceration were noted. With partial weight bearing at 4 weeks, satisfactory gait recovery was obtained at 5 to 8 months (in conjunction with protective sensation recovery). Sural fasciomyocutaneous perforator flap is a reliable modality in heel construction, showing advantages of low ulceration rate, durability, and good protective sensation recovery compared with conventional free tissue transfer and local fasciocutaneous perforator flap.

Keywords

heel reconstruction - perforator flap - fasciocutaneous flap - myocutaneous flap
 

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