Two Cases of a Distally Based Sural Flap for Reconstruction of a Large Skin Defect at the Heel Pad

Abstract

We report two patients with large soft tissue defects on the weight-bearing heel that were reconstructed with a distally based sural flap, with a literature review.
[Case 1] A 69-year-old man had a large area of necrotic skin on his sole secondary to severe crush injury due to a motorcycle accident. Reconstruction with a sural flap was performed, and the patient is now able to walk using plantar inserts. He has reacquired good activity of daily life without obstacles, such as ulcer formation, despite a loss of sensation. [Case 2] A 52-year-old man with poorly controlled diabetes developed a severe infection of the sole due to minor injuries that resulted in an extensive tissue defect of the heel after debridement of the infected necrosis tissue. Reconstruction with a sural flap was performed, and the patient regained the ability to walk with normal shoes using a plantar insert plate.
The distally based sural flap is one of the most commonly used flaps for reconstructing tissue defects around the lower leg and ankle joints. Sufficient thickness to withstand load walking and sufficient volume to wear commercially available shoes were achieved in both patients, suggesting this to be a useful method.