Functional Outcomes After Heel Pad Reconstruction: A Review of 7 Cases

Luen, Koh Khai; Sulaiman, Wan Azman Wan

doi:10.1053/j.jfas.2017.04.024

Cited by 21 publications

(17 citation statements)

References 32 publications

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“…Therefore, the instep medial plantar flap, harvested as a fasciocutaneous flap, is recognized as one of the preferred flaps, giving its advantage of local regional tissues. The flap offers thin, pliable glabrous tissue that is easily contoured and neurotized, providing potential for sensitization [7].…”

Section: Discussionmentioning

confidence: 99%

Heel Pad Reconstruction With Medial Plantar Flap

Langat

Sulaiman

2021

Cureus

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The heel of the foot is covered by highly specialized thick, glabrous skin containing fibroadipose tissue with numerous fibrous septae traversing the subcutaneous tissue, which acts as a shock-absorbent and prevents shearing of the skin. The loss of heel pad would cause interruption of the propelling function of the foot during walking. Therefore, heel pad reconstruction is an important procedure for wound closure in the acute phase and also functional reconstruction in delayed cases. We report a case of heel pad deformity in a patient who presented to us with left heel pain and inability to fully bear weight, which has caused her walking difficulty, following a road traffic accident. She sustained a degloving injury of the left foot and an open fracture of left calcaneum with ruptured Tendon Achilles in which the wound was initially addressed with failed reverse sural flap and the wound was allowed to heal by secondary intention. Delayed heel reconstruction was carried out with a propeller medial plantar flap and split skin graft. Postoperatively, the patient had improved functional and esthetic outcome.

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Section: Discussionmentioning

confidence: 99%

Heel Pad Reconstruction With Medial Plantar Flap

Langat

Sulaiman

2021

Cureus

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“…Reconstruction in this area must adequately withstand friction and shearing forces from shoe wear and maintain a low profile. The medial plantar artery flap is commonly used for small wounds of the heel pad and ankle (Cohen et al, 1999; Duman et al, 2002; Gu et al, 2017; Khai Luen & Wan Sulaiman, 2017; Oh, Moon, Cha, Koh, & Chung, 2011; Scaglioni, Rittirsch, & Giovanoli, 2018; Schwarz & Negrini, 2006; Siddiqi, Hafeez, Cheema, & Rashid, 2012). For slightly larger or proximal defects, the reverse sural flap or propeller flaps are options (Benito‐Ruiz, Yoon, Guisantes‐Pintos, Monner, & Serra‐Renom, 2004; El‐Shazly & Yassin, 2006; Lu, Chai, Wang, & Wen, 2014; Maffi, Knoetgen III, Turner, & Moran, 2005; Xu & Lai‐Jin, 2008).…”

Section: Discussionmentioning

confidence: 99%

Long‐term clinical and patient‐reported outcomes in free flap reconstruction of the weight‐bearing heel pad and non‐weight‐bearing Achilles tendon regions

et al. 2020

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Background The non‐weight‐bearing (NWB) Achilles tendon and weight‐bearing (WB) heel pad regions are technically challenging to reconstruct with distinct functional and aesthetic considerations that have not been previously considered in the literature. This study is the first to characterize the long‐term clinical and patient‐reported outcomes of these components to better inform patients about the postreconstruction period. Methods A retrospective review of medical records and phone‐based survey of adult patients who underwent free flap reconstruction of the heel/ankle with 6‐month minimum clinical follow‐up was performed. Results Forty‐three patients, with 31 (72.1%) NWB and 12 (27.9%) WB defects, treated from January 1, 2000 to February 28, 2017 were included. Muscle flaps were more common than fasciocutaneous flaps (N = 36 [83.7%] vs. 7 [16.3%]). Flap survival rate was 95.3% and limb salvage rate was 93.0% at median follow‐up of 12.0 months (interquartile range [IQR] 6.2, 25.5). Flap ulceration occurred more frequently in the WB region (41.7 vs. 6.5%, p = .0123). The survey response rate was 63.6%. The majority of patients complete daily tasks with no/little impairment (76.2%), walk half a mile or more (85.7%), returned to work (86.6%), and fit shoes “fair” or “well” (71.4%). Most patients were “very satisfied” with heel/ankle function (71.4%) and would “very likely” undergo the same procedure if needed (76.2%). Conclusions Free flap reconstruction in both the NWB Achilles tendon and WB heel pad has excellent limb salvage and flap survival rates. Patients were satisfied with heel/ankle function, but additional counseling is recommended for variance in appearance and higher ulceration rates in WB defects.

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“…Following the PSMP flap was the DBRS flap and following after that were the musculocutaneous flaps. Based on these results, this review concluded the PSMP flap as the preferred flap for small-to-moderate sized heel defects based its early return of deep sensation [13].…”

Section: Latissimus Dorsi Flapmentioning

confidence: 98%

“…Reconstruction for soft tissue defects using the free LD flap was reviewed in 190 patients ( Table 1). We reviewed the LD flap in three separate studies; as a universal option in all reconstructive areas in comparison to the ALT flap, for functional outcomes after heel pad reconstruction, and in free flap reconstruction for diabetic foot limb salvage [10,13,17]. Defects ( Table 4) were reported at the lower extremity (n = 181), heel pad (n = 7) and foot (n = 8).…”

Section: Latissimus Dorsi Flapmentioning

confidence: 99%

“…A review of seven cases was performed to evaluate the functional outcomes after heel pad reconstruction using the free LD flap (n = 1), free serratus anterior flap (n = 1), free senate medial plantar flap (n = 1), pedicle sensate medial plantar flap (n = 3) and the distally based reverse sural flap (n = 1) [13]. Etiology of the defects included trauma (n = 3), diabetic ulcer (n = 2), melanoma (n = 1), and recurrent ulcer after reconstruction with the reverse sural flap (n = 1).…”

Section: Latissimus Dorsi Flapmentioning

confidence: 99%

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A Systematic Review of Outcomes and Flap Selection Following Lower Extremity Free Tissue Transfer Versus Vascularized Perforator Pedicle Flap Transfer in Lower Limb Reconstruction

Rodriguez-Collazo

Khan

DiPierro

et al. 2018

International Journal of Orthoplastic Surgery

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The evolution of microsurgery and orthoplastics has expanded our ability as surgeons to manage complex lower extremity soft tissue defects. This evolution relies on the understanding of reconstructive surgical principles for problem solving and analyzing outcomes. The purpose of this review is to determine flap selection with a focus on reliability based on the outcomes of lower extremity free tissue transfer versus vascularized perforator pedicle flap transfer in lower limb reconstruction. A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the databases PubMed/MEDLINE. Data were compiled by reviewing the number of patients, age, comorbidities, complications, size and location of defect. Outcomes were analyzed by indicated soft tissue defect size, location and cause, as well as subsequent flap size, type, survival, durability and their functional results. Overall, 72 topic related studies from 2014-2017 were reviewed. Sixteen of the 72 met the final inclusion criteria. Patient study sizes from the included articles ranged from 7-428 cases. The current qualitative systematic review of flap transfer in the lower extremity has contributed a summary of reported outcomes in literature thus far. After analyzing existing evidence, our study found no significant differences between reconstructive options with a paucity of evidence to clearly recommend the ideal flap transfer for microsurgical reconstruction of lower extremity soft tissue defects.

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Functional Outcomes After Heel Pad Reconstruction: A Review of 7 Cases

Cited by 21 publications

References 32 publications

Heel Pad Reconstruction With Medial Plantar Flap

Heel Pad Reconstruction With Medial Plantar Flap

Long‐term clinical and patient‐reported outcomes in free flap reconstruction of the weight‐bearing heel pad and non‐weight‐bearing Achilles tendon regions

A Systematic Review of Outcomes and Flap Selection Following Lower Extremity Free Tissue Transfer Versus Vascularized Perforator Pedicle Flap Transfer in Lower Limb Reconstruction

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