Lateral Calcaneal Artery Perforator/Propeller Flap in the Reconstruction of Posterior Heel Soft Tissue Defects

Introduction  Posterior heel soft tissue defects with/without tendoachilles injury are difficult to reconstruct because of bony prominence, limited expendable local soft tissues, and significant donor site morbidity. In this study, we evaluate the lateral calcaneal artery (LCA) perforator/propeller flap for posterior heel soft tissue defect reconstruction. Materials and Methods  A preliminary cadaveric study was done on 22 specimens to study the course of the LCA and its perforators. The knowledge gleaned from the cadaveric study was applied in our clinical study. The clinical study was conducted from January 2018 to May 2023 in 13 patients (10 males and 3 females) with posterior heel defects. The primary movement of the perforator flaps were either V-Y advancement ( n  = 10) or propeller ( n  = 3). Results  All the flaps settled well except for superficial epidermolysis in one patient (7.69%) which healed conservatively. The average follow-up period was 14.53 months. Postoperatively, all patients had normal gait and normal range of movements. The LCA with the maximum number of perforators in the retrofibular/retromalleolar segment and the islanded flaps based on these perforators provided the excellent coverage for tendoachilles insertion defects and posterior heel defects facilitating excellent shoeability in all cases. Conclusion  The study concludes that the LCA perforator/propeller flap may be a reliable cover for the posterior heel defects with good color, texture, thickness, and contour match rendering a shoeable stable foot.