[Freestyle free perforator flaps for heel reconstruction]

Abstract

Introduction: Heel coverage requires the surgeon to considerate of multiple parameters: the type of defect, the exposed tissues, the weight-bearing requirements, the donor site morbidity, and the shape of the reconstructed heel allowing at best normal footwear. Although many methods of coverage exist, they are often chosen at the cost of a compromise between all the parameters described. In recent years, perforator freestyle free flaps offer plastic surgeons an unparalleled freedom that can adapt the constraints of the reconstruction while minimizing the functional and scar donor site morbidity.

Patients and methods: We present four cases of heel defect of different origins treated by three types of tailored perforator freestyle free flaps (ALT, TAP and SCIP Flaps). End-to-side anastomosis to the posterior tibial vessels was used in three flaps while one flap was anastomosed to the internal plantar artery in an end-to-end fashion.

Results: No postoperative complication occurred. This approach allowed, in all patients, a reconstruction of excellent quality with minimal cicatricial morbidity. All patients were walking effectively at 21 days postoperatively.

Conclusion: Perforator freestyle free flaps offer a solution of first choice for heel reconstruction. At the price of a linear hidden scar, they offer a functional, aesthetic and durable coverage.

Keywords: Couverture; Coverage; Freestyle; Freestyle free flap; Heel; Lambeau perforant; Perforator flap; Reconstruction; Talon.