Reconstruction of ankle and heel defects by a modified wide-base reverse sural flap

Flap reconstruction around the ankle and heel is a technically demanding procedure. Some patients have contraindications for microsurgery, however, limiting the options for local tissue transfer. In this study, we describe our experience with a new flap technique for ankle and heel coverage.

We designed a modified wide-base reverse sural flap and applied it to 20 patients with lower leg trauma from 1994 to 1997. All patients sustained Gustilo type IIIb,c open fractures with soft-tissue defects around the ankle and heel. Six cases had chronic osteomyelitis. Most of our patients had contraindications for microsurgery such as old age, poor medical condition, or heavy smoker status. The average age was 69.5 years old, and the average follow-up time was 18.5 months.

All 20 patients underwent successful modified reverse sural flap reconstruction. There were no deep infections, no soft-tissue necrosis, or pressure ulcers. The nonunion rate was 5%. The average time for flap elevation and rotation was 29.3 minutes. No blood transfusion was required. An unsightly scar was the major complaint (60%) from our patients. Seventeen cases (85%) achieved good functional outcomes.

This report demonstrates that our design of this modified wide-base reverse sural flap is suitable for flap reconstruction around the ankle and heel; especially for patients who have difficulty in receiving microsurgery. The surgical procedure is simple, and the results are satisfactory.