[Application of flap in repair of heel skin and soft tissue defect].
OBJECTIVE
To introduce the experience and comprehend of application of many kinds of skin flaps in repair of heel skin and soft tissue defect.


METHODS
From August 1993 to April 2007, 242 cases of skin and soft tissue defect on heel were treated. There were 157 males and 85 females aged 27-76 years. There were 35 cases of unstable scar, 46 cases of chronic ulcer, 57 cases of squamous cell carcinoma, 72 cases of malignant melanoma and 32 cases of injury. The defect area ranged from 2 cm x 2 cm to 8 cm x 14 cm, wound was with low-grade infection in 51 cases. The course of disease was 1 hour to 5 years. The lateral calcaneal flaps (34 cases), the dorsum pedis flaps (15 cases), the medial plantar artery island flaps (108 cases), the sural neurovascular flaps (36 cases), the saphenous neurocutaneous vascular flaps (26 cases) and free (myocutaneous) skin flaps (23 cases) were used to repair heel wounded surface according to specific location of heel wounded surface, range of skin and soft tissue defect. The size of the (myocutaneous) skin flap was 3.0 cm x 2.5 cm to 15.0 cm x 9.0 cm. The donor area was directly sutured or covered with skin grafts.


RESULTS
In 242 cases, 235 cases achieved healing by first intention, 5 cases had partial necrosis of flaps, 2 cases had mild infection. The donor area healed by first intention. A total of 217 patients were followed up for 1 month to 60 months. The color of flaps were normal and the texture of flaps were softer than that of normal heel tissue; the flaps were wearable, the shape of flaps were satisfactory. The patients can walk after 6 months of operation, and the gait was normal. In 118 cancer patients, no local tumor recurrence occurred, and distant metastatic lesions were observe in 22 malignant melanoma patients. In 32 cases of malignant melanoma followed up 60 months, no distant metastatic lesions were found.


CONCLUSIONS
In base of following the primary disease treatment, heel function reconstruction and contour structural feature remodeling, we adopted some kind of island or free (myocutaneous) skin flap can be used to repair heel wound. The ideal effect in heel function reconstruction and contour structural feature remodeling were obtained.
Li
Li
L
Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, PR China.
Xue
Chunyu
C
Li
Junhui
J
Zhang
Jingde
J
Xing
Xin
X
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000293:injuries; D016038:Skin Transplantation; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps