The Treatment Experience of Different Types of Flaps for Repairing Soft Tissue Defects of the Heel

Bo Feng,* Guang-Ming Dai,* Yong-Jun Wang, Lan Zhang, Ke-Cheng Niu Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Inner Mongolia Medical University, Baotou, 014010, People’s Republic of China*These authors contributed equally to this workCorrespondence: Bo Feng Tel +86 13347173738Email femgbo@aliyun.comObjective: To summarize the clinical application effects of three different types of flaps for repairing soft tissue defects of the heel, and to discuss the importance of tissue repair and heel reconstruction.Methods: A total of 46 cases with skin tissue defects of the heel with deep tissue exposure were treated. The reasons for the defect were trauma (n = 26), burns and electric shocks (n = 12), chronic ulcers (n = 2), postoperative infection of the calcaneus and Achilles tendon (n = 5), and tumor resection (n = 1). The scope of wound defect was 2.0× 2.5 to approximately 15.0× 20.0 cm. The flaps used were medial plantar island flaps (n = 9), distal pedicled sural neurovascular island flaps (n = 23), and free anterolateral thigh (perforator) flaps (n = 14). The flap cutting range was 3.0× 3.5 to approximately 16.0× 22.0 cm.Results: After surgery, all 46 flaps survived. In two cases, patients experienced partial epidermal necrosis at the distal end of the flap that healed after local dressing exchange, and after this treatment, the complete skin grafts survived. Follow-up was conducted in 40 cases, with an average follow-up duration of 8.2 months (3– 44 months) and the two-point discrimination of 5– 14 mm. The average American Orthopaedic Foot and Ankle Society scale was 89.2 points with good flap color and texture, satisfactory appearance, and normal gait.Conclusion: The repair method should be selected according to the“ 5-zone method”: The plantar medial island flap is suitable for small area ( 10 cm) joint area defects.Keywords: surgical flap, heel, functional reconstructio