Outcome Evaluation of Skin-Grafted Free Muscle Flap versus Reverse Sural Fasciocutaneous Flap in Soft Tissue Reconstruction of Weight-Bearing Heel

Abstract

There were eighteen patients received soft tissue reconstruction of weight-bearing heel at our institution in past 10 years. Eleven patients received skin-grafted free muscle flaps and seven received reverse sural fasciocutaneous flaps. The etiology of the wounds were osteomyelitis (55.6%), necrotizing fasciitis (11.1%), trauma (11.1%) and tumor resection (11.1%). The patients who received free muscle flap surgery were younger (average 45.2 y/o), had much larger wound size (12.4x 6.6cm^2) longer operative time, and less hospital days. The complication rate was comparable between these two modalities. They all achieved a considerable successful rate and limb salvage rate. The muscle flap group presented as higher percentage in resuming walking and working. It also had better functional score but higher chance of chronic ulcer. In consideration of weight-bearing heel reconstruction, the skin-grafted muscle flap seems to be the first choice. In elder patient or patient who is not suitable for long operative time, reverse sural fasciocutaneous flap is probably an alternative with acceptable successful rate but less functional result is expected.