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.
Level of Clinical Evidence
Keywords
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Article info
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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