title: Complex heel reconstruction with a sural fasciomyocutaneous perforator flap.
abstract: Reconstruction of weight-bearing surfaces at the foot and ankle is controversial. Free tissue transfer and local fasciocutaneous perforator flaps are preferred for plantar reconstruction, but high rates of flap breakdown and ulceration have caused unsatisfactory functional outcomes. We present a modified "sural fasciomyocutaneous perforator flap" and its functional outcome. Between January 2007 and September 2010, 19 patients were treated for soft-tissue defects in the weight-bearing area with sural fasciomyocutaneous perforator flaps. The gastrocnemius, preserved in the base of the flap, was applied as padding under the calcaneus. In follow-up from 9 to 25 months (mean 13.8 months), each patient's pain score, defect size, ulcer formation, protective sensation recovery, and normal footwear were analyzed. The majority of the flaps survived with satisfactory aesthetic and functional results. One case of partial flap loss and one case of delayed ulceration were noted. With partial weight bearing at 4 weeks, satisfactory gait recovery was obtained at 5 to 8 months (in conjunction with protective sensation recovery). Sural fasciomyocutaneous perforator flap is a reliable modality in heel construction, showing advantages of low ulceration rate, durability, and good protective sensation recovery compared with conventional free tissue transfer and local fasciocutaneous perforator flap.
authors.affiliation: Department of Repair and Reconstruction, Shanghai 6th People's Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China.
authors.forename: Shengdi
authors.initials: S
authors.lastname: Lu
authors.affiliation: Department of Repair and Reconstruction, Shanghai 6th People's Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China.
authors.forename: Yimin
authors.initials: Y
authors.lastname: Chai
authors.affiliation: Department of Repair and Reconstruction, Shanghai 6th People's Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China.
authors.forename: Chunyang
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Repair and Reconstruction, Shanghai 6th People's Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China.
authors.forename: Gen
authors.initials: G
authors.lastname: Wen
mesh_terms: D000328:Adult; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D006365:Heel / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000601:surgery; D010147:Pain Measurement; D061525:Perforator Flap / Q000098:blood supply; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D013497:Sural Nerve / Q000098:blood supply*; D016896:Treatment Outcome; D014456:Ulcer / Q000209:etiology; D016474:Weight-Bearing