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
