title: Calcaneal reconstruction with free fibular osteocutaneous flap.
abstract: Due to the role of the calcaneus in weight bearing, soft tissue coverage along with proper reduction of the fracture is the treatment following open calcaneal injury. Intra-articular calcaneal fractures present a very difficult management problem, as the lack of soft tissue and the intricate vascularity in this area pose a risk of complications. Coverage with local and free muscle flaps following excision of infected structures is a common approach for the treatment of chronic osteomyelitis. However, it is unknown which type of flap is optimal for the treatment of lateral foot wounds, especially when complicated by calcaneal osteomyelitis. A patient presented with an open wound over the lateral aspect of the heel with exposed hardware and chronic osteomyelitis of the calcaneus. Following multiple debridements, an ipsilateral osteocutaneous free fibular flap was transferred to the bony defect. Weight bearing was initiated at 2 months postoperatively, and he now ambulates with a normal gait, has normal plantar sensation, and has no difficulty maneuvering stairs. The patient has done well postoperatively and has recovered full range of motion and complete mobility. In this case report, an osteocutaneous free flap provided an excellent outcome for an active patient with a very complex and complicated condition.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Medical University of South Carolina, Charleston, South Carolina. barbour@musc.edu
authors.forename: John
authors.initials: J
authors.lastname: Barbour
authors.forename: Stuart
authors.initials: S
authors.lastname: Saunders
authors.forename: Langdon
authors.initials: L
authors.lastname: Hartsock
authors.forename: Dennis
authors.initials: D
authors.lastname: Schimpf
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Neill
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D001860:Bone Plates; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods*; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery; D020878:Device Removal; D005360:Fibula / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery; D005597:Fractures, Open / Q000175:diagnosis / Q000601:surgery; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery; D058752:Free Tissue Flaps; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods*; D013380:Subtalar Joint / Q000293:injuries* / Q000601:surgery; D014945:Wound Healing / Q000502:physiology