Clin Orthop Surg.  2009 Mar;1(1):1-5. 10.4055/cios.2009.1.1.1.

Lateral Calcaneal Artery Adipofascial Flap for Reconstruction of the Posterior Heel of the Foot

• Chung MS
• Baek GH
• Gong HS
• Rhee SH
• Oh WS
• Kim MB
• Lee KH
• Kim TW
• Lee YH

• KMID: 1127907
• DOI: http://doi.org/10.4055/cios.2009.1.1.1

Abstract

BACKGROUND: Soft tissue defects of the posterior heel of the foot present difficult reconstructive problems. This paper reports the authors' early experience of five patients treated with a lateral calcaneal artery adipofascial flap.
METHODS
Between 2003 and 2007, five patients (3 males and 2 females) with soft-tissue defects over the posterior heel underwent a reconstruction using a lateral calcaneal artery adipofascial flap and a full-thickness skin graft. The flap sizes ranged from 3.5 x 2.5 cm to 5.5 x 4.0 cm.
RESULTS
All five flaps survived completely with no subsequent breakdown of the grafted skin, even after regularly wearing normal shoes. The adipofascial flap donor sites were closed primarily in all patients.
CONCLUSIONS
Lateral calcaneal artery adipofascial flaps should be included in the surgical armamentarium to cover difficult wounds of the posterior heel of the foot. These flaps do not require the sacrifice of a major artery to the leg or foot, they are relatively thin with minimal morbidity at the donor site, and leave a simple linear scar over the lateral aspect of the foot.

Keyword

Foot; Posterior heel; Soft tissue defect; Lateral calcaneal artery adipofascial flap

MeSH Terms

Adipose Tissue/surgery
Adult
Aged
Child
Child, Preschool
Fascia/surgery
Female
Heel/*surgery
Humans
Male
Skin/surgery
Soft Tissue Injuries/*surgery
*Surgical Flaps/blood supply

Figure

• 

  Fig. 1 (A) Post-traumatic soft tissue defect with exposure of the calcaneus and Achilles tendon in a 4-year-old female. (B) Design of the lateral calcaneal artery flap showing its vascular supply from the lateral calcaneal artery. The adipofascial flap was obtained from the same territory as the lateral calcaneal artery skin flap. (C) The overlying skin was dissected at this venous plane. (D) The flap was dissected and the lateral calcaneal artery and the lesser saphenous vein could then be visualized. (E) The flap pivot point lies proximal to the superior edge of the calcaneus where the lateral calcaneal artery emerges. (F) The donor site was closed primarily with the preserved skin without grafting. (G) The flap was rotated to the recipient area, and a suction drain was inserted. (H) Appearance of an early granulating bed area at 7 days after surgery. (I) A sheet of full-thickness skin was grafted onto the raw surface of the flap. (J) Reconstructed area showing a good contour and appearance at 12 months postoperatively. (K) Primary healing and linear scar at the donor site at 18 months postoperatively. No functional impairment of ankle motion was evident. (L) The donor site healed primarily without a hypertrophic scar. Note the excellent ankle joint motion.

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