Abstract
Purpose and background
To assess feasibility and functional acceptability of lateral calcaneal artery fascio-cutaneous flap (LCAFCF) in providing cover to posterior heel defects in single stage.
Aims and objectives
To provide stable and sensate cover to small and moderate posterior heel defects.
Materials and methods
This review was conducted in department of Burns & Plastic Surgery of Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana between October 2021 and September 2022 to analyse the clinical outcome of LCAFCF in 24 patients (18 males, 6 females) aged between 20 and 35 years who had chronic dry wounds n = 9, failed primary reconstruction by reverse sural flap n = 1, granulated wounds n = 8, exposed achilles tendons n = 4 and scarred tissue restricting ankle joint movements n = 2 in region of posterior heel following trauma, while riding motor-cycle. Course of lateral calcaneal artery was marked with hand-held doppler. Flap size ranged from 3 to 3.5 cm in width and 5.5–7.5 cm length. The donor sites were split skin grafted. Sutures were removed on 22nd day of surgery. Mean follow up was 13 months.
Results
All flaps survived. Two had partial loss of skin graft and two developed hyperkeratosis on grafted site. Sensations in flap, regain of movements of ankle joint, comfort of walking and driving were acceptable.
Conclusions
LCAFCF is handy, safe and reliable flap for re-surfacing difficult wounds of posterior heel, therefore should be included in surgical armamentarium.
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References
Krishna, D., Chaturvedi, G., Khan, M. M., Cheruvu, V. P. R., Laitoniam, M., & Minz, R. (2021). Reconstruction of heel soft tissue defects: An algorithm based on our experience. World Journal of Plastic Surgery, 10(3), 63–72. https://doi.org/10.29252/wjps.10.3.63. PMID: 34912668.
Grabb, W. C., & Argenta, L. C. (1981). The lateral calcaneal artery skin flap (the lateral calcaneal artery, lesser saphenous vein, and sural nerve skin flap). Plastic and Reconstructive Surgery, 68, 723–730.
Reddy, G. R., Mohan, A. R. C. H., Jyothsna, B., Reddy, D. B. S., & Srilakshmi, C. (2020). Lateral calcaneal artery Island flap. IOSR Journal of Dental and Medical Sciences, 19(7), 01–04.
Holmes, J., & Rayner, C. R. W. (1984). Lateral calcaneal artery island flaps. British Journal of Plastic Surgery, 37, 402–405.
Gang, R. K. (1987). Reconstruction of soft-tissue defect of the posterior heel with a lateral calcaneal artery island flap. Plastic and Reconstructive Surgery, 79, 415–419.
Ishikawa, K., Kyutoku, S., & Takeuchi, E. (1990). Free lateral calcaneal flap. Annals of Plastic Surgery, 24, 10–16.
Chung, M. S., Baek, G. H., Gong, H. S., Rhee, S. H., Oh, W. S., Kim, M. B., Lee, K. H., Kim, T. W., & Lee, Y. H. (2009). Lateral calcaneal artery adipofascial flap for reconstruction of the posterior heel of the foot. Clinics in Orthopedic Surgery, 1(1), 1–5. https://doi.org/10.4055/cios.2009.1.1.1
Ishikawa, K., Isshiki, N., Hoshino, K., & Mori, C. (1990). Distally based lateral calcaneal flap. Annals of Plastic Surgery, 24(1), 10–16.
Wang, S. J., Kim, Y. D., Huang, H. H., Wu, Z. Y., Lu, L., Chen, H. F., Guo, X. R., & Wei, X. H. (2015). Lateral calcaneal artery perforator-based skin flaps for coverage of lower-posterior heel defects. Journal of Plastic, Reconstructive and Aesthetic Surgery, 68(4), 571–579. https://doi.org/10.1016/j.bjps.2014.12.027. Epub 2015 Jan5. PMID: 25752717.
Freeman, B. J., Duff, S., Allen, S., et al. (1998). The extended lateral approach to the hind foot: Anatomical basis and surgical implications. Journal of Bone and Joint Surgery. British Volume, 80, 139–143.
Clofu, R. N., Zamfirescu, D. G., Popescu, S. A., & Lascar, I. (2017). Reverse sural flap for ankle and heel soft tissues reconstruction. Journal of Medicine and Life, 10(1), 94–98. PMID: 28255387; PMCID:PMC 5304383.
Bhattacharya, V., & Reddy, G. R. (2005). Distal perforator based cross leg flaps for leg and foot defects. IJPS, 38(1), 18–21.
Ahn, D. K., Lew, D. H., Roh, T. S., & Lee, W. J. (2015). Reconstruction of ankle and heel defects with peroneal artery perforator-based pedicled flaps. Archives of Plastic Surgery, 42, 619–625. https://doi.org/10.5999/aps.2015.42.5.619
Potparic, Z., & Rajacic, N. (1997). Long-term results of weight-bearing foot reconstruction with non-innervated and reinnervated free flaps. British Journal of Plastic Surgery, 50, 176–181. https://doi.org/10.1016/S0007-1226(97)91366-7
Chairat, B., Pattaya, T., Paiboon, K., Anuchit, R., Anont, P., & Chaichoompol, S. (2015). Lateral calcaneal artery flaps in atherosclerosis: cadaveric study, vascular assessment and clinical applications. Plastic and Reconstructive Surgery - Global Open, 3(9), e517. https://doi.org/10.1097/GOX.0000000000000502
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Singh, A., Singh, R., Sharma, A. et al. Critical Evaluation of Lateral Calcaneal Artery Fascio-Cutaneous Flap in Re-Surfacing Posterior Heel Defects: A Review of 24 Cases. JOIO 57, 1423–1434 (2023). https://doi.org/10.1007/s43465-023-00912-8
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DOI: https://doi.org/10.1007/s43465-023-00912-8