Free flap reconstruction of plantar weight‐bearing heel defects: Long‐term functional and patient‐reported outcomes

Abstract

Purpose Non‐healing plantar weight‐bearing heel ulcers are a challenging problem to treat. Free tissue transfer (FTT) reconstruction of the heel is an opportunity for limb salvage to preserve gait and ambulation. The aim of this study is to describe surgical and functional outcomes in patients who underwent FTT to treat chronic heel ulcers. Methods A retrospective review of patients who underwent FTT for plantar heel ulcers from 2011 to 2021 was conducted. Patient demographics, comorbidities, perioperative data, postoperative complications, and long‐term outcomes were recorded. Primary outcomes included flap success, complications, postoperative ambulation, patient‐reported outcome measures and limb salvage, with patients stratified into limb salvage or eventual amputation groups. RESULTS Forty‐four patients underwent 45 heel reconstructions. Average age and BMI were 57.3 years and 30.1 kg/m2, respectively. Thirty‐eight patients (86.4%) had calcaneal osteomyelitis, 35 patients (79.5%) had diabetes, and 18 patients (40.9%) had peripheral vascular disease (PVD). Immediate microsurgical success rate was 95.6%. At mean follow‐up of 19.6 ± 20.9 months, overall limb salvage rate was 73.3% (n = 33). Preoperative albumin levels were higher in limb salvage group compared to the amputation group (3.0 vs. 2.4 g/dl, p = .018). Prior stroke history and hypoalbuminemia were significantly higher in the amputation group compared to limb salvage group (p = .012 and p = .018, respectively). Risk for eventual amputation was associated with PVD (OR 4.0, p = .053), hypoalbuminemia (OR 4.9, p = .020), and postoperative infection (OR 6.3, p = .013). Of the 12 amputations that occurred, the most common indication for amputation was infection (n = 8, 66.7%), which most often occurred at the original wound location (62.5%). At most recent follow‐up, 90.7% of patients (n = 39) were ambulatory. CONCLUSION FTT is an effective alternative to amputation in patients with chronic heel ulcers. Proper patient selection, preoperative optimization, and postoperative care are imperative to the success of this limb salvage procedure.

Ortho‐oncoplastic surgery in foot and ankle: A narrative overview on reconstruction of soft‐tissue defects after oncologic resections

“…One‐hundred‐fourteen full‐text articles were assessed for eligibility. Seventy of these were excluded and the remaining forty‐four have been divided based on type of technique reported: local flaps (Liu et al, 2014; Masquelet et al, 1992; Nguyen et al, 2023; Ring et al, 2016; Woo et al, 2022; Zelken & Lin, 2016), free flaps (Akdag et al, 2018; Battiston et al, 2015; Calotta et al, 2018; Cherubino et al, 2020; Colterjohn et al, 1997; He et al, 2022; Kim et al, 2021; Kozusko et al, 2019; Medina 3rd et al, 2014; Musharafieh et al, 2001; Namdar et al, 2010; Nosrati et al, 2012; Periasamy et al, 2023; Sailon et al, 2009; Sayyed et al, 2022; Ulusal et al, 2005; Yu et al, 2021), perforator flaps (D'Arpa et al, 2014; Ellabban et al, 2020; Khan et al, 2020; Kwon et al, 2021; Lee et al, 2017; Li et al, 2021; Lin et al, 2021; Pignatti et al, 2011; Ring et al, 2016; Toia et al, 2017), skin grafts (Asif et al, 2018; Kang et al, 2019; Leclère & Casoli, 2016; Schneider et al, 2009; Shimizu & Kishi, 2012) and free bone (fibula) or osteocutaneous transfer (de Boer et al, 1990; El‐Gammal et al, 2002; Han et al, 1992; Toma et al, 2007).…”

“…The ALT flap is a versatile option for lower extremity reconstruction that utilizes the septocutaneous and musculocutaneous branches of the descending branch of the lateral circumflex femoral artery (Sayyed et al, 2022). Its location and versatility make it a popular choice, with the ability to cover defects as large as 20 × 30 cm (Cherubino et al, 2020; Sayyed et al, 2022). Because of its thin and pliable nature, the ALT flap is particularly well‐suited for reconstructing defects in the foot and ankle (Figure 2).…”