Purpose: The reconstruction of a soft tissue defect of the heel pad can be challenging. One vital issue is the restoration of the ability of the heel to bear the load of the body weight. Many surgeons prefer to use local flaps or free tissue transfer rather than a skin graft. In this study, we evaluated the criteria for choosing a proper flap for heel pad reconstruction. Methods: In this study, 23 cases of heel pad reconstruction were performed by using the flap technique. The etiologies of the heel defects included pressure sores, trauma, or wide excision of a malignant tumor. During the operation, the location, size and depth of the heel pad defect determined which flap was chosen. When the defect size was relatively small and the defect depth was limited to the subcutaneous layer, a local flap was used. A free flap was selected when the defect was so large and deep that almost entire heel pad had to be replaced. Results: There was only one complication of poor graft acceptance, involving partial flap necrosis. This patient experienced complete recovery after debridement of the necrotic tissue and a split thickness skin graft. None of the other transferred tissues had complications. During the follow-up period, the patients were reported satisfactory with both aesthetic and functional results. Conclusion: The heel pad reconstructive method is determined by the size and soft-tissue requirements of the defect. The proper choice of the donor flap allows to achieve satisfactory surgical outcomes in aesthetic and functional viewpoints with fewer complications.
Reconstruction of Heel and Sole Defects by Free Flaps
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Kim DC, Kim SS, Ha DH, Yoo HJ, Lee DH: Reconstruction for the soft tissue defect of heel using free lateral arm neurosensory flap. J Korean Microsurg Soc 8: 15, 1999
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Serafin D, Georgiade NG, Smith DH: Comparison of free flaps with pedicled flaps for coverage of defects of the leg or foot. Plast Reconstr Surg 59: 492, 1976
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Ponten B: The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg 34: 215, 1981
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Free flap reconstruction of the foot.
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Lee YJ, Ahn HC, Choi SS, Hwang WJ: Reversed adipofascial flap in lower leg: can it replace the free flap? J Korean Soc Plast Reconstr Surg 32: 100, 2005
Sensory Reinnervation in Microsurgical Reconstruction of the Heel
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Comparison between sensitive and nonsensitive free flaps in reconstruction of the heel and plantar area.
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Colen LB, Uroskie T Jr: Foot reconstruction. In Mathes SJ:Plastic surgery. 2nd ed, Philadelphia, Saunders Elsevier, 2006, p 1417
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May JW, Halls MJ, Simon SR: Free microvascular muscle flaps with skin graft reconstruction of extensive defects of the foot: a clinical and gait analysis study. Plast Reconstr Surg 75: 627, 1985