Reconstruction of Complex Soft Tissue Defects of the Heel With Versatile Double Skin Paddle Anterolateral Thigh Perforator Flaps: An Innovative Way to Restore Heel Shape.

BACKGROUND

Complex heel defects constitute a significant challenge for plastic surgeons.

OBJECTIVES

In this study, versatilities of free double skin paddle ALT flaps in the reconstruction of complex soft tissue defects of heels were explored.

METHODS

From January 2010 to December 2019, 16 patients (13 male and 3 females) aged 16-74 years underwent double skin paddle ALT flap reconstruction in our department. All the patients had large defects located at the heel, and 5 had a dead space. Underlying structures such as vessels, bones, and tendons were exposed in all cases.

RESULTS

Flap survival rate was 100% after the reconstruction. Eleven double skin paddle ALT flaps and 5 vastus lateralis muscle-chimeric double skin paddle ALT flaps were used. The size of the skin flap ranged from 9.5 × 4.5 cm to 22 × 10 cm, and the size of a muscle segment ranged from 6 × 3 × 1 cm to 10 × 3 × 2 cm. The mean follow-up was 22.6 months (range: 10-81 months). The wounds healed well, providing reliable soft tissue coverage and good heel contour. All the patients ambulated independently during the follow-up period. Most of them regained protective sensation. The average two-point discrimination was 32.7 mm (range: 27-37 mm).

CONCLUSION

Double skin paddle ALT flaps are a feasible option for the reconstruction of complex heel defects, with good functional and aesthetic results. Nonetheless, further studies comparing double skin paddle ALT flaps to other flap techniques are needed.