Reconstruction of Heel Soft Tissue Defects: An Algorithm Based on Our Experience

Area of Science:

• Orthopedic Surgery
• Plastic Surgery
• Reconstructive Surgery

Background:

• Heel soft tissue reconstruction aims for sensory recovery and flap durability.
• Flap selection depends on defect size, location, and donor site availability.

Purpose of the Study:

• To evaluate the outcomes of various flaps used for heel defect reconstruction.
• To compare functional outcomes between neuropathic and non-neuropathic heel ulcers.

Main Methods:

• Retrospective study of 40 patients with heel defects from Jan 2016 to Dec 2018.
• Inclusion of diverse flap types: medial plantar artery islanded, extended reverse sural, islanded reverse sural, local, cross-leg, and free Latissimus Dorsi flaps.
• Evaluation of flap survival, sensation recovery, coverage durability, and functional outcomes, including a comparison between neuropathic and non-neuropathic ulcers.

Main Results:

• Various flaps were utilized, with extended reverse sural flaps being the most common (16 cases).
• Immediate complications were minimal (2 cases of marginal necrosis).
• Delayed ulceration occurred in 6 flaps; however, return of protective sensation and American Orthopaedic Foot and Ankle Society subjective scores were significantly higher in non-neuropathic ulcers (P=0.006 and P=0.025, respectively).

Conclusions:

• Locoregional flaps are effective for covering most heel defects, yielding satisfactory results.
• Functional outcomes are poorer in reconstructed neuropathic heel ulcers.