Abstract
Background:
Various surgical flaps have been described for the reconstruction of post traumatic soft tissue defects of the heel. These techniques are not all familiar to orthopaedic surgeons. The presented technique is based on the use of a reverse flow island sural flap combined with a circular external fixator.
Material:
This presentation is a review of 8 cases performed between 2003 and 2012.
Results:
All cases were males with an average age of 39 years (16–56) with a follow up period between 2 and 10 years. The soft tissue defects were located around the heel and Achilles tendon as a result of road traffic accidents involving motor cycles. Six patients had associated bony injuries of the foot and ankle related to the soft tissue defect.
All flaps remained viable, and cover was easily achieved with direct closure. Three cases required debridement of subsequent superficial necrosis and additional split skin grafting. Although the flaps are insensate per design, there were no associated problems of late onset pressure ulcers.
The circular fixation added the additional benefit of protection and easy access of the posterior flap during the post-operative period. Mild venous congestion was a temporary feature, of no long term consequence.
Conclusion:
The sural fasciocutaneous flap is a useful adjunct for the treatment of complex soft tissue defects around the heel and ankle. The main advantages include simplicity of design and easy execution, avoids the need for complex microsurgical techniques and can be performed with simple loupe magnification, and thus realistically falls within the realm of the treating orthopaedic surgeon.
