The musculocutaneous sural artery flap for soft-tissue coverage after calcaneal fracture

Abstract

Soft-tissue defects following calcaneal fractures can be covered in a relatively easy and safe procedure. We have modified the familiar distally based sural artery flap by lifting a part of the gastrocnemius muscle. With an inferior pedicle, this musulocutaneous flap can be rotated onto the defect on the sole of the foot and on the heel. Five patients with open fractures of the calcaneus or wound necrosis after osteosynthesis were treated with this procedure. Two defects were covered uneventfully, two flaps were prepared, the rotation being done in a secondary procedure. One patient demanded further revisions, and the flap was partially lost, but the remaining defect was covered after open treatment. This new musculocutaneous sural artery flap can be used for covering even an extensive defect after calcaneal fractures and seems to be a reliable procedure. Morbidity at the donor site is low, and in the case of failure, the free flap remains an alternative.

Surgical Treatment of Calcaneal Comminuted Intrarticular Fractures: Long-Term Follow-Up

“…Coverage by a sural flap (musculo-cutaneous rotational flap from the soleus) [17] was done with excellent results.…”

Distally based sural fasciomyocutaneous flap: Anatomic study and modified technique for complicated wounds of the lower third leg and weight bearing heel

“…[5][6][7][8][9][10][11][12][13][14][15] This technique has been specially applied for reconstruction of soft tissue defects complicated with osteomyelitis. Our anatomic study found that there were usually 2-3 communicating branches connecting the sural vascular axis to the gastrocnemius muscle in the 4 cm overlapping length proximal to the junction of tendon-muscle belly.…”

“…Different types of the flap can be designed based on its pedicle and components, such as fasciocutaneous, fasciosubcutaneous, adipofascial, and fasciomyocutaneous flaps. 3 The distally based sural fasciomyocutaneous flap including a gastrocnemius muscle fragment or muscle cuff carried beneath the deep fascia was described by Al Qattan, 4 Le Fourn et al, 5 and Mueller et al 6 in 2001, respectively. The fasciomyocutaneous flap has been shown to provide bulk and high metabolic viable muscle component for repairs of the soft tissue defects complicated with osteomyelitis and/or deep dead space.…”

Free scapular or parascapular flaps for soft tissue damage accompanying talus or calcaneus fractures

“…Bei Defekten größer als 5 cm sind gestielte Muskellappen am Sprunggelenk nicht mehr einsetzbar. Ebenso wenig sind der distal gestielte Suralislappen [3,24], der Peroneallappen, der Arteria-dorsalis-pedis-Lappen, der Plantaris-medialis-Lappen oder der M. abductor digiti minimi für ausgedehnte Defekte am OSG oder Fuß geeignet [17] und sie hinterlassen nicht unwesentliche Hebedefekte [23].…”

“…Sofern die Sensibilität der gewichtstragenden Metatarsalköpfchen vorhanden ist, stellt der (Para-)Skapularlappen nach unserer Erfahrung auch eine wertvolle Möglichkeit zur Defektdeckung der Teilbelastungszone dar [2,23,24]. Hierzu zählen neben der mittleren Plantarregion der Fußrücken und der perimalleoläre Bereich (.…”