Free tissue transfers for reconstruction of weight-bearing heel defects: Flap selection, ulceration management, and contour revisions

Ahmet H. Sakarya, Kun Yu Tsai, Chung Chen Hsu, Shih Heng Chen, Nicholas K. Do, Madonna R. Anggelia, Chih Hung Lin, Cheng Hung Lin*

*此作品的通信作者

研究成果: 期刊稿件文章同行評審

5 引文 斯高帕斯(Scopus)

摘要

Background: Soft tissue defects in the weight-bearing heel represent a reconstructive challenge because of tissue complexity and lack of local/regional coverage. This study presents our reconstruction outcomes of different defect aetiologies, reconstruction timing, and flap selection. Methods: Patients with weight-bearing heel defects who underwent free tissue transfer from 2003 to 2014 and with at least 6 months of follow-up were retrospectively reviewed. Flap types (fasciocutaneous vs muscle/musculocutaneous), timing of reconstruction (early vs subacute vs delayed), and defect aetiology were compared in terms of flap failure, vascular complications, and ulceration. Results: Seventy-four flaps were used to reconstruct weight-bearing heel defects in 70 patients. Defect aetiology included trauma in 53 patients (75%), chronic wound in 12 patients (17%), and tumour resection in 6 patients (8%). Flap survival was 97% (72/74). There was no significant difference in flap failures between muscle and fasciocutaneous flaps. The timing of reconstruction showed no difference in flap survival. There was a significant difference in ulceration rate between the trauma and non-trauma groups (p = 0.001). Twenty-eight ulcers (39%) developed, 12 (43%) of which presented 3 years postoperatively, while only 6 cases (21%) presented within one year postoperatively. Conclusion: Our experience represents one of the highest survival rates reported regarding free flap weight-bearing heel reconstruction. The anterolateral thigh flap was our first choice for extensive heel defects. Ulceration incidence was directly related to trauma and tends to develop 3 years after reconstruction. Delayed reconstruction was at least as safe as early or subacute reconstruction though with less need for debulking.

原文英語
頁(從 - 到)1557-1566
頁數10
期刊Journal of Plastic, Reconstructive and Aesthetic Surgery
75
發行號5
DOIs
出版狀態已出版 - 05 2022
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Publisher Copyright:
© 2021 British Association of Plastic, Reconstructive and Aesthetic Surgeons

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