Reversed saphenous fasciocutaneous island flap in marjolin's ulcers

Abstract

Background The reconstruction of the heel represents a challenge due to the limited local soft tissue availability and also due to the special structural and functional characteristics of this region. A great number of possibilities have been described; we represent a new flap for heel reconstruction which is a modified form of sural fasciocutaneous flap. Methods Ten patients (two female and eight male; median age 68 years, range 48–76) underwent reversed saphenous fasciocutaneous island flap after wide excision of heel lesion. The causes of heel lesions in all patients were Squamous Cell Carcinoma on the chronic burn's scar. In this new technique, sural nerve and artery were saved and blood supply to flap is based on lesser saphenous vein. Mean lesion surface was 60 cm 2 (range 30–112 cm 2). Results Epidermolysis and flap discoloration were seen in three patients but treated with intermittent wet dressing and conservative managements. One patient showed partial necrosis in flap circumference which recovered with debridment and skin graft. Total flap necrosis was not seen in any patients. Mean hospital stay was 10 days (range 8–15 days). The mean follow up was 12 months (rang 6–18 months). Conclusion Reversed saphenous fasciocutaneous island flap is an option for heel reconstruction. In contrast with sural flap, sural nerve and artery are saved.