Case Report| Volume 57, ISSUE 3, P627-631, May 2018

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Case Report: Late Reconstruction of the Land Mine–Injured Heel With an Osteomyocutaneous Composite Fibular Flap

Published:December 25, 2017DOI:


      The heel comprises the epidermis, minimal subcutaneous tissue, a dense septum, and the calcaneus. Injury to any of these structures can impair the ability to walk. The soft tissue or calcaneal bone can be injured by trauma. Injuries incurred in war are usually high-energy traumas caused by weapons such as rifles, rockets, and land mines. Such injuries can be life threatening and involve the loss of tissue, including skin, soft tissue, bone, and neurovascular tissue. Two main treatment protocols are used for such injuries with large tissue defects: amputation and reconstruction. We describe a reconstruction with an osteomyocutaneous fibular flap for a heel injury. At the 2-year follow-up point, the patient had 30% loss of ankle range of motion. The visual analog scale score had dramatically decreased from 8 to 1, and the patient was satisfied with the result. In conclusion, patients with significant problems such as infection, pain, and anatomic deterioration of the calcaneus can be successfully treated using an osteomyocutaneous fibular flap in a single surgery.

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        • Stanec Z.
        • Krivić A.
        • Stanec S.
        • Zic R.
        • Budi S.
        Heel reconstruction with an iliac osteocutaneous free flap: 10-year follow-up.
        Ann Plast Surg. 2004; 53: 174-177
        • Cai J.
        • Cao X.
        • Liang J.
        • Sun B.
        Heel reconstruction.
        Plast Reconstr Surg. 1997; 99: 448-453
        • Celikoz B.
        • Sengezer M.
        • Işik S.
        • Turegun M.
        • Deveci M.
        • Duman H.
        • Acikel C.
        • Nisanci M.
        • Ozturk S.
        Subacute reconstruction of lower leg and foot defects due to high velocity-high energy injuries caused by gunshots, missiles, and land mines.
        Microsurgery. 2005; 25: 3-14
        • Siebert C.H.
        • Hansen M.
        • Wolter D.
        Follow-up evaluation of open intra-articular fractures of the calcaneus.
        Arch Orthop Trauma Surg. 1998; 117: 442-447
        • Attinger C.
        • Cooper P.
        Soft tissue reconstruction for calcaneal fractures or osteomyelitis.
        Orthop Clin North Am. 2001; 32: 135-170
        • Noever G.
        • Brüser P.
        • Köhler L.
        Reconstruction of heel and sole defects by free flaps.
        Plast Reconstr Surg. 1986; 78: 345-352
        • Reiffel R.S.
        • McCarthy J.G.
        Coverage of heel and sole defects: a new subfascial arterialized flap.
        Plast Reconstr Surg. 1980; 66: 250-260
        • Vitkus K.
        • Vitkus M.
        Reconstruction of large infected tibia defects.
        Ann Plast Surg. 1992; 29: 97-106
        • Boffeli T.J.
        • Collier R.C.
        Near total calcanectomy with rotational flap closure of large decubitus heel ulcerations complicated by calcaneal osteomyelitis.
        J Foot Ankle Surg. 2013; 52: 107-112
        • Lykoudis E.G.
        • Gantsos A.
        • Dimou A.O.
        Complex calcaneal defect reconstruction with osteotomized free fibula–flexor hallucis longus osteomuscular flap.
        Microsurgery. 2013; 33: 63-68
        • Han C.S.
        • Wood M.B.
        • Bishop A.T.
        • Cooney III, W.P.
        Vascularized bone transfer.
        J Bone Joint Surg Am. 1992; 74: 1441-1449
        • Anđelković S.Z.
        • Vučković Č.Ð.
        • Palibrk T.D.
        • Milutinović S.M.
        • Bumbaširević M.Ž.
        Open dislocation of the high ankle joint after fibular graft harvesting.
        J Foot Ankle Surg. 2015; 54: 1158-1161
        • Peek A.
        • Giessler G.A.
        Functional total and subtotal heel reconstruction with free composite osteofasciocutaneous groin flaps of the deep circumflex iliac vessels.
        Ann Plast Surg. 2006; 56: 628-634
        • Endo J.
        • Kuniyoshi K.
        • Mochizuki M.
        • Shimoyama K.
        • Koyama T.
        • Aiba A.
        • Kadota R.
        • Sasaki Y.
        Two-staged hindfoot reconstruction with vascularized fibula graft for calcaneal osteomyelitis caused by methicillin-resistant Staphylococcus aureus: a case report.
        Microsurgery. 2013; 33: 232-235
        • Lorenzetti F.
        • Lazzeri D.
        • Bonini L.
        • Giannotti G.
        • Piolanti N.
        • Lisanti M.
        • Pantaloni M.
        Distally based peroneus brevis muscle flap in reconstructive surgery of the lower leg: postoperative ankle function and stability evaluation.
        J Plast Reconstr Aesthet Surg. 2010; 63: 1523-1533
        • Ozturk S.
        • Bayram Y.
        • Mohur H.
        • Deveci M.
        • Sengezer M.
        Evaluation of late functional results of patients treated with free muscle flaps for heel defects caused by land-mine explosions.
        Plast Reconstr Surg. 2005; 116: 1926-1936