Clinical application of posterior calf fascio-cutaneous pedicle flap in leprosy foot ulcer.

Lower extremities of the leprosy patients are characterized by the decreased sensation of the foot from peripheral nerve damage. As a result, repetitive foot ulcers are frequently seen. When these repetitive shallow ulcers become infected, they result in deep soft tissue ulcers and even osteomyelitis. The treatment of these ulcers in leprosy is a challenging problem both to the patient himself and to medical personnel. Conventional treatment methods for these ulcers include, according to the wound condition, skin graft, local flap, long-term cast immobilization, wedge resection of the joint and even amputation in severe cases. But all these methods have the disadvantages of frequent recurrences, long hospitalization periods and permanent foot deformities. Recently in Korea, despite the decreased occurrences of new patients and the decreased frequencies of facial and hand deformity formation due to the active early diagnosis and treatment, there still exists a large number of foot deformities resulting from decreased foot sensation. Moreover, treatment modalities are not definitely established. In fact, there are many environmental difficulties in applying the free flap transfer to the foot ulcer of leprosy patients in leprosy sanatorium as opposed to treating the non-leprosy patients. And so, from 1990 to 1993, we performed 6 superior-based posterior calf cross leg flap transfers and 1 distal-based flap transfer, under spinal anesthesia, referred by the leprosy sanatorium for deep foot ulcers. We obtained favorable results in 6 patients and partial necrosis in a patient who received distal based flap transfer.