Reconstruction of the weight-bearing heel with nonsensate reverse sural artery flaps

Park, Ji Hun; Choi, In Cheul; Hong, Tae Chang; Kang, Jong Woo; Park, Jong Woong

doi:10.1016/j.injury.2021.04.007

Cited by 5 publications

(2 citation statements)

References 29 publications

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“…These flaps can be used as proximally based flaps for heel reconstruction and as distally based flaps for forefoot reconstruction (Park et al, 2017). However, in cases of substantial defects or poor vascularity, or when these flaps cannot be used due to injury to the plantar region, reverse sural flaps (RSF) or free anterolateral thigh flaps (ALTF) can be utilized (Acar et al, 2015; Ellabban et al, 2022; Park et al, 2021; Xu et al, 2021). The RSF is a useful option for heel reconstruction, but it may not be suitable for relatively larger forefoot defects, in which case a ALTF can be considered (Krishna et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Comparison of instep and non‐instep flap in the reconstruction of the weight‐bearing portion of the forefoot and heel

Lee,

Ku,

Kim

et al. 2024

Microsurgery

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BackgroundInstep flaps are commonly used for the reconstruction of weight‐bearing areas of the foot. However, in cases of large defects or damage to the instep area, non‐instep flaps such as reverse sural flaps (RSF) or free anterolateral thigh flaps (ALTF) can be employed. Previous studies have primarily focused on heel reconstruction when comparing different flaps, without considering the forefoot. This study aims to verify the clinical outcomes of these flaps and determine the appropriate donor site for weight‐bearing areas of the foot including forefoot reconstruction.MethodsIn a retrospective study, 39 patients who had undergone flap reconstruction of weight‐bearing area defects in the foot with a follow‐up period of ≥1 year were included. The patients were categorized into two groups: Group A (n = 19) using instep flaps, and Group B (n = 20) using non‐instep flap including RSFs and ALTFs. Surgical outcomes were assessed based on the success of the flap, the presence of partial necrosis, the number of additional surgeries, and complications related to the donor site. Clinical evaluation included visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score, and the occurrence of ulcers.ResultsAll flaps were successful, while partial necrosis occurred in one case in Group B. There were three reclosures after flap border debridement in both groups and one donor site debridement in Group A. The VAS scores during weight‐bearing were 2.0 ± 1.1 and 2.2 ± 1.5 for Groups A and B, respectively (p = .716). The AOFAS scores were 52.8 ± 6.8 and 50.2 ± 12.7 for Groups A and B, respectively (p = .435). The occurrence of ulcers was 0.4 ± 0.9 times for Group A and 0.3 ± 0.7 times for Group B, with no significant difference between the two groups (p = .453).ConclusionThere was no difference in clinical outcomes between the types of flaps after reconstruction of the forefoot and hindfoot. Therefore, it is recommended to choose the appropriate flap based on factors such as the size of the defect, its location, and vascular status rather than the type of flap.

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Section: Introductionmentioning

confidence: 99%

Comparison of instep and non‐instep flap in the reconstruction of the weight‐bearing portion of the forefoot and heel

Lee,

Ku,

Kim

et al. 2024

Microsurgery

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“…The combination of neuropathy‐induced loss of the protective sensation of the heel, pressure bearing, and the reduced perfusion from a paucity of blood vessels in the region often result in the complicated ulcerations seen in the diabetic patient population. This weight‐bearing region additionally lacks soft tissue elasticity, resulting in defects frequently involving tendon and bone exposure (Park et al, 2021). This makes the reconstructive aim of creating a safe and durable weight‐bearing surface for patients a difficult achievement.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Dual-Perforator Flap With Wide Pedicle Versus Sural Neurocutaneous Flap With Peroneal Artery Perforator in the Treatment of Soft Tissue Defects of Foot and Ankle

Huang¹,

Wang²,

Xu³

et al. 2023

The Journal of Foot and Ankle Surgery

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Reconstruction of the weight-bearing heel with nonsensate reverse sural artery flaps

Cited by 5 publications

References 29 publications

Comparison of instep and non‐instep flap in the reconstruction of the weight‐bearing portion of the forefoot and heel

Comparison of instep and non‐instep flap in the reconstruction of the weight‐bearing portion of the forefoot and heel

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

Dual-Perforator Flap With Wide Pedicle Versus Sural Neurocutaneous Flap With Peroneal Artery Perforator in the Treatment of Soft Tissue Defects of Foot and Ankle

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