Sural nerve neurocutaneous cross-foot flap

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Heel ulcers often recur despite conventional treatments like grafts and flaps.
• Recurrence is frequently linked to the loss of sensation in the affected area.
• Managing chronic, infected heel ulcers presents significant clinical challenges.

Observation:

• A patient with a degloving injury to the heel developed a chronic, infected ulcer after a full-thickness skin graft.
• Local tissue was insufficient for wound coverage.
• A neurocutaneous flap, designed to incorporate the sural nerve, was chosen for reconstruction.

Findings:

• The neurocutaneous cross-foot flap provided both adequate padding and crucial sensation to the heel.
• The sural nerve from the flap was successfully anastomosed to the recipient leg's sural nerve.
• The patient, who is very active, experienced no recurrence of the heel ulcer post-surgery.

Implications:

• This technique offers a viable solution for recurrent heel ulcers, particularly those with sensory deficits.
• Restoring sensation is key to preventing future breakdown and improving functional outcomes.
• Neurocutaneous flaps represent a promising reconstructive option for complex lower extremity defects.