Heel reconstruction with free instep flap: a case report

Abstract

IntroductionReconstruction of weight-bearing heel defects remains a challenge because of the unique characteristics of the plantar skin. Though numerous surgical reconstructive options have been reported, the instep flap represents an ideal option and seems to be more acceptable to patients than others. However, when the heel defect expands to the instep area, the ipsilateral instep is not available for flap elevation. A free instep flap harvested from the contralateral foot can be a good solution, but this method has been scarcely reported.Case presentationA 41-year-old Asian man presented to our institution with a soft-tissue lesion in the weight-bearing heel and instep area. His heel was reconstructed with a free instep flap from the other foot, end-to-side anastomosis of its medial plantar artery to the recipient posterior tibial artery and end-to-side coaptation of the cutaneous sensory fascicles of the flap to the medial plantar nerve.ConclusionThe flap survived successfully, and no ulceration occurred in the flap. At the last follow-up appointment at 30 months post-surgery, a very good functional and aesthetic outcome was verified, indicating that the suggested approach may prove to be the treatment of choice in selected cases of weight-bearing heel reconstruction.

Microvascular Muscle vs. Fascio-Cutaneous Free Flaps for Reconstruction of Plantar Load-Bearing Foot Defects—An International Survey

“…In cases of an impaired donor site on the injured foot, these flaps can also be employed from the contralateral side. Given their limited size or reach, they are suitable only for defects of moderate size [ 20 , 21 , 22 ]. Further locoregional flaps are, for example, the intrinsic muscle flaps, the toe island, and fillet flaps [ 8 ].…”

Free tensor fascia lata true‐perforator flap transfer for reconstruction of the calcaneal soft tissue defect complicated with osteomyelitis in a patient with alcohol‐induced Charcot foot: A case report and literature review

“…There are several articles reporting free flap reconstructions for heel soft tissue defects (Table 1) (Al Maksoud et al, 2016; Chou et al, 2018; Elgohary et al, 2018; El‐Shazly et al, 2008; Grauberger et al, 2020; Han et al, 2020; Kang et al, 2013; Khai Luen & Wan Sulaiman, 2017; Kim et al, 2016; Kuran et al, 2000; Liu et al, 2014; Oh et al, 2011; Park et al, 2017; Song et al, 2016; Van Landuyt et al, 2005; Yücel et al, 2000). Medial plantar and medialis pedis (MP) flap are ones of the most popular flaps for heel reconstruction, mainly as pedicled flaps.…”

Reconstruction of the plantar toe with a distal reverse instep sensory island flap

“…The medial and lateral nerve branches of the second toe were exposed, and then the medial branch was dissected. The distal stump of the dissected medial branch was sutured to the lateral branch trunk using the end‐to‐side technique (Liu et al, ), and the proximal stump was prepared for end‐to‐end anastomosis to the DRISI flap nerve (Figure ). The flap donor site was covered with a thick split‐thickness graft from the groin.…”

“…Moberg first described the use of a pedicled island flap in the foot with similar tissue coverage (Ramanujam & Zgonis, 2010), and different studies reported that the instep region has been successfully repaired in defects of the heel, the great toe, and other parts involved in plantar foot reconstruction (Liu, Zhou, Cao, Cao, & Cai, 2014;Ramanujam & Zgonis, 2010;Siddiqi, Hafeez, Cheema, & Rashid, 2012;Uygur et al, 2008). Accordingly, distal reverse instep island flap seemed to be a suitable choice for most of the plantar first toe defects.…”