A description of one method of reconstructing problematic soft tissue defects of the heel. It is always good to have several techniques available in your quiver, so that you can choose the most appropriate arrow for any particular problem. This technique, at least in the authors’ hands, is reliable, with only one partial flap loss in 21 consecutive cases, but all achieving good healing. The flap is pedicled on perforating vessels from the posterior tibial artery. The choice of flap coverage for this notoriously difficult area lies between local flaps, such as the instep flap, or longer flaps, such as the one described, or free tissue transfer. The size of the defect will often decide which flap will be chosen, together with the surgeon’s experience. The most frequent problem with these difficult cases is recurrence of the ulceration in insensate flaps. The authors report a zero recurrence of re-ulceration, but the maximum follow-up time was 21 months and these patients are permanently at risk.

Large heel soft tissue defects managed successfully with reverse medial crural fasciocutaneous flap: A 7-year single centre experience with 21 consecutive cases.
Jing-Chun Z, Kai S, Jia-Ao Y, et al.
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