Modified pedicled tongue-like skin extension fasciocutaneous flaps for heel reconstruction; a versatile technique

Abstract

Soft-tissue reconstruction for isolated heel defects represents a challenging surgical dilemma due to tight inelastic tissue and inevitable acute angulations of the fibro-vascular pedicle of local flaps. A modified pedicled flap with a tongue-like skin extension has been designed to eliminate tunnel tightness to avoid traction injury and kinking of the blood vessel. Between 2003 and 2005, eight patients with isolated heel defects were analysed (six men, two women). Their age ranged from 5 to 47 years (median age = 31). Six were traumatic while two were neuropathic. Reversed sural (n = 4), medial planter (n = 3) and one dorsalis pedis artery fasciocutaneous flap were used. The average follow-up period was 1 year during which the flaps were monitored for venous congestion, ischemia, superficial epidermolysis and partial or total flap loss. Only one modified pedicle flap showed mild venous congestion; on the other hand, no other ischemic events such as superficial epidermolysis or flap loss were experienced. The modified tongue-like process extension is considered a valuable tool to increase the versatility of these flaps.