Free-flap salvage of soft tissue complications following the lateral approach to the calcaneus.
Soft tissue complications including wound slough and/or infection after lateral foot incisions used to approach the calcaneus are notoriously frequent. Simpler wound management may be possible when early, aggressive treatment is deployed. If definitive coverage has been delayed, local options typically become unreliable. Free tissue transfers may then become the mainstay for limb salvage. Over the past 2 decades in our joint experience in managing such complications referred to us, 8 free flaps were necessary in 7 patients who all had had some form of traumatic injury to the calcaneus. The mean interval from wound compromise to coverage was an exceedingly long 88.1 days (range: 29-166 days). The gracilis muscle was our choice for tissue transfer in every patient as this is a versatile, thin, yet wide-enough muscle with a pedicle length satisfactory to allow reach to nearby recipient sites. There were no flap-related untoward events, with all completely surviving. The anterior tibial/dorsalis pedis axis served as the usual recipient site (87.5%) for microanastomosis. Fixation hardware was retained whenever possible. All limbs were ultimately salvaged to allow reasonable ambulation.
Hallock
Geoffrey G
GG
Division of Plastic Surgery, The Lehigh Valley Hospitals, Allentown, PA, USA. pbhallock@cs.com
Arangio
George A
GA
D000328:Adult; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery*; D020878:Device Removal; D005260:Female; D005413:Flatfoot / Q000601:surgery; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000601:surgery*; D005593:Fracture Fixation, Internal; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps