Complex Heel Defect: A Comprehensive Study On Combined Regional Flaps For Sensate And Stable Coverage.

Abstract

BACKGROUND: Heel defect has remained a challenging situation for reconstructive surgeons. In large post traumatic defects, the goal is to provide a sensate and stable soft tissue coverage, especially for the weight-bearing part of the heel. The paucity of local tissue options makes the scenario difficult to deal with. OBJECTIVE: This study is aimed to reconstruct large defect, involving both the weight-bearing and non-weight-bearing part of the heel by combining two regional flaps. METHODS: A retrospective study, comprising of 11 patients from January 2016 to December 2019 with large traumatic heel defects, operated in our setup with combined medial plantar and reverse sural artery flap within 72 hours of injury. Follow up period was 6 months postoperatively. RESULT: All flaps survived well except one reverse sural flap, which was congested and later debrided and 2 had distal edge necrosis which were managed conservatively. All the reverse sural flaps were noted to have lymphedema, but only 3 patients opted for debulking surgery. The functional outcome was excellent, with all the patients being able to walk normally, both barefoot and with footwear. The weight-bearing area was sensate, a clear advantage of utilizing instep skin. CONCLUSION: In our experience, the combined strategy of utilizing local tissue for large heel defects, not only provides a sensate, stable, and reliable coverage but also avoids the lengthy procedure of free tissue transfer that in the end would not be able to give similar results.