Surgical Reconstruction for Large Defects of the Heel and Plantar Area

Abstract

Large defects of the heel and plantar area caused by trauma represents a challeng for reconstructive surgeons. The aim of this report is to review three cases of soft-tissue defect of the heel and plantar area that were reconstructed by free flaps in our institution. The average age of the patients was 52.0 years old, with a mean defect size of 385cm². Free latissimus dorsi (LD) flap was used in all cases. One case combined medial plantar flap was applied using the chimeric flap technique, and in another case, combined scapular flap was applied using the same pedicle. Sensory nerve coaptation was not performed for any of the flaps. Fasciocutaneous lesion of the flap covered the weight-bearing area and the non-weight-bearing area was covered by a myocutaneous area with split-thickness skin graft. The mean follow-up period was 3.5 years. There was no loss of flaps. The patients regained walking and daily activities without orthosis after multiple secondary operations, mainly debulking operations. Our experience showed that, even using non-sensory tissue, covering a large defect with a free latissimus dorsi flap and covering the weight-bearing area with fasciocutaneous tissue are keys to successful soft-tissue reconstruction.