Microsurgical reconstruction of the heel: evaluation and decision-making recommendations based on a case series

Reconstruction of the calcaneal region presents unique challenges due to its complex anatomy and critical weight-bearing function. This retrospective study aims to report our experience in cases of calcaneal defects repaired with various free flap types, and to evaluate the long-term outcomes of the reconstructions. We retrospectively reviewed 25 patients who underwent microsurgical free flap reconstruction for calcaneal defects between January 1997 and March 2022. Demographics, defect characteristics, surgical techniques, and outcomes were analyzed. Out of the 25 cases, 18 patients (72%) were male, with a median age of 55 years. Successful reconstructions were achieved in 24 patients (96%) using various free flap types: ALT flap (8cases), Parascapular flap (4 cases), Gracilis flap (5 cases), TAP flap (5 cases), Radial forearm flap (2 cases), and in one case, deep circumflex iliac artery (DCIA) osteocutaneous flap. These reconstructions demonstrated good functional recovery and minimal complications. Only one case (4%) experienced flap failure due to venous thrombosis, necessitating revision surgery without success. The most frequent complication was the sliding (6 cases) due to the excessive bulk which was addressed with revision surgery. The average follow-up period was 8 months, with patients regaining satisfactory ambulation and improved quality of life. Based on our results, microsurgical free flap reconstruction has proven to be a valuable technique for addressing calcaneal defects and, according to many Authors, it offers a high success rate and favorable long-term outcomes. In selected cases, revision surgery may be necessary to address bulk-related issues.