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Functional Outcomes After Heel Pad Reconstruction: A Review of 7 Cases

  • Koh Khai Luen
    Correspondence
    Address correspondence to: Koh Khai Luen, MRCS, Reconstructive Sciences Department, Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan 16150, Malaysia.
    Affiliations
    Plastic and Reconstructive Surgical Trainee, Reconstructive Sciences Department, Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu, Malaysia
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  • Wan Azman Wan Sulaiman
    Affiliations
    Associate Professor and Consultant Plastic and Reconstructive Surgeon, Reconstructive Sciences Department, Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu, Malaysia
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      Abstract

      Sensate, durable heel pad reconstruction is challenging. The present study assessed the functional outcomes after heel pad reconstruction using various flap techniques at our institution. From June 2011 to June 2016 (5-year period), 7 consecutive patients underwent heel pad reconstruction for various etiologies, with 3 microvascular free flaps (42.9%; 2 musculocutaneous flaps [66.7%] and 1 contralateral medial plantar flap [33.3%]) and 4 local pedicle flaps (57.1%; 3 instep medial plantar artery flaps [75.0%] and 1 distally based reverse sural flap [25.0%]). The patient records and demographic data were reviewed, and surgically related information was obtained and analyzed. The subjective components of the American Orthopaedic Foot and Ankle Society hindfoot clinical ratings scale were used to evaluate the pain and functional outcomes. Sensation was assessed using Semmes-Weinstein monofilaments, and ulcer recurrence was recorded. The mean age of the patients was 41.7 (range 11 to 70) years, the mean defect size was 59 (range 12 to 270) cm2, and the mean follow-up duration was 22 (range 15 to 43) months. Complete flap survival was achieved without significant complications in all 7 patients. Patients treated with the sensate medial plantar artery flap recorded the highest mean American Orthopaedic Foot and Ankle Society score of 57.3 (maximum score of 60) and experienced a return of deep sensation at 6 (range 6 to 24) months and protective sensation at 1 year. This was followed by the reverse sural flap and the musculocutaneous flap. No recurrent heel ulceration was observed in our series of patients. In conclusion, the sensate medial plantar flap is a satisfactory method for coverage of small- to moderate-size heel defects.

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