Heel coverage by a plantar myocutaneous island pedicle flap

Defects of the heel represent a difficult reconstructive problem. Previously described methods have not always been ideal especially for the posterior heel. The weight-bearing functional requirements of the heel tissue over the calcaneus are a sensitive, well padded, durable cover. The technique of choice should provide local similar tissue plus involve a single reliable operative procedure. Skin grafts placed on the calcaneus or on a muscle transposition flap, such as the flexor digitorum brevis, abductor hallucis, or abductor digiti minimi muscle, provide a thin, insensitive, and dissimilar surface. The cross-foot, cross-leg, cross-thigh, and buttock flaps provide more bulk and thicker skin. These flaps involve a prolonged hospitalization, multiple procedures, increased morbidity, and insensitive tissue. The dorsal foot island flap and microvascular free flaps are a one-stage procedure with less morbidity. The donor tissue is still too dissimilar to provide the protection and durability to this area. Random plantar flaps have provided a functional replacement with similar tissue having adequate sensation. However, these random flaps are not always reliable, have limited motion, and are limited usually to small defects. Recently the myocutaneous flap has been proposed using the flexor digitorum brevis muscle. This neurovascularized flap is larger and more reliable. Our dissection study of plantar tissue using microlatex injected feet has expanded the plantar flap for easier heel coverage and provided a predictable flap area. By mobilizing the pedicle proximally to the posterior tibial artery, the flap has an expanded coverage arc. Thus the heel is covered with a sensitive and durable tissue to allow weight bearing, frictional trauma, and ambulation.