Lateral calcaneal artery perforator-based skin flaps for coverage of lower-posterior heel defects.
BACKGROUND
Perforator-based flaps have been explored across almost all of the lower leg except in the Achilles tendon area. This paper introduced a perforator flap sourced from this area with regard to its anatomic basis and clinical applications.


METHODS
Twenty-four adult cadaver legs were dissected to investigate the perforators emerging along the lateral edge of the Achilles tendon in terms of number and location relative to the tip of the lateral malleolus, and distribution. Based on the anatomic findings, perforator flaps, based on the perforator(s) of the lateral calcaneal artery (LCA) alone or in concert with the perforator of the peroneal artery (PA), were used for reconstruction of lower-posterior heel defects in eight cases. Postoperatively, subjective assessment and Semmes-Weinstein filament test were performed to evaluate the sensibility of the sural nerve-innerved area.


RESULTS
The PA ended into the anterior perforating branch and LCA at the level of 6.0 ± 1.4 cm (range 3.3-9.4 cm) above the tip of the lateral malleolus. Both PA and LCA, especially the LCA, gave rise to perforators to contribute to the integument overlying the Achilles tendon. Of eight flaps, six were based on perforator(s) of the LCA and two were on perforators of the PA and LCA. Follow-up lasted for 6-28 months (mean 13.8 months), during which total flap loss and nerve injury were not found. Functional and esthetic outcomes were good in all patients.


CONCLUSIONS
The integument overlying the Achilles tendon gets its blood supply through the perforators of the LCA primarily and that of through the PA secondarily. The LCA perforator(s)-based and the LCA plus PA perforators-based stepladder flap is a reliable, sensate flap, and should be thought of as a valuable procedure of choice for coverage of lower-posterior heel defects in selected patients.
Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China.
Sui-Jiang
SJ
Wang
Second People(')s Hospital of Zhongshan, Zhongshan, Guangdong, China.
Yu-Dan
YD
Kim
Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China.
Hai-hua
HH
Huang
Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China.
Ze-Yong
ZY
Wu
Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China.
Ling
L
Lu
Department of Human Anatomy, Guangdong Medical College, Zhanjiang, Guangdong, China.
Hai-Fang
HF
Chen
Second People(')s Hospital of Zhongshan, Zhongshan, Guangdong, China.
Xiao-Rui
XR
Guo
Shilong BoAi Hospital of Dongguan, Dongguan, Guangdong, China.
Xiao-Hua
XH
Wei
D000125:Achilles Tendon; D000293:Adolescent; D000328:Adult; D002102:Cadaver; D002648:Child; D005260:Female; D006365:Heel / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods*
Defect; Hindfoot; Lateral calcaneal artery; Perforator flap; Peroneal artery; Reconstruction