[Repair and reconstruction of tissue defect of heel and sole]

Traumatic tissue loss about heel and sole in 49 patients, acute in 19 and chronic with infection or ulcer in 30, were repaired or reconstructed primarily or in stages. 31 patients had cutaneous and subcutaneous defect only, the other 18 patients had additional bone loss. In covering the skin defect, simple skin flap was used in 30 cases and composite flap in 19, being vessel-pedicled free flap 21 occasions and vessel-pedicled local flap 28 occasions. For the cases with bone defect, 5 of them requiring bone-grafting were repaired with osseo-cutaneous flaps from leg or trunk. To restore the sensation of the flap, nerve-pedicled dorsal flap was transposed to the sole in 10 cases, and nerve reconstruction, either anastomosing the nerve in flap to a nearby dorsal cutaneous nerve or sural nerve or implanting certain sensory nerve fibers into the flap, was performed on the other 39 cases. Follow-up examination, 1 to 5 years after operation, found that all the flaps healed up nicely with good sensation of pain and touch, and 27 of them (57.1%) even restored fine senses. Bone graft united soundly to its host in every case, resulting in satisfactory function of the foot. At all the events, through debridement and replacing the detached tissue, in acute case, back to its original site brought about excellent result. Details in every aspect of the operation were discussed.