Curative effect of lateral retromalleolar perforator flap in repair of heel skin defect

CHEN Xin; MA Guang-yi; SONG Li; GAO Zhi-yu; ZHANG Jian-hua; LIU Ben-quan; ZHU Hai-feng; WANG Ya-ke

doi:10.3969/j.issn.1009-4237.2018.05.012

Abstract：Objective To observe the curative effect of lateral retromalleolar perforator flap in repair of heel skin defect.Methods During May 2014 and Oct.2016,a total of 17 patients with lateral,posterior,plantar, or trans-regional skin defect were admitted into our department.There were 12 males and 5 females,with an average age of 33.5 years(15-57 years).Among them,14 cases had trans-regional skin defect induced by trauma,and 3 ca-ses showed exposure of the plate due to necrosis of the skin after open reduction and internal fixation of calcaneal fracture.Meanwhile,the range of skin defect was 2cm×4cm-7 cm×10cm.Furthermore,11 patients were found to have combined calcaneal fracture,among which there were 6 cases of bony defect of the calcaneus and 5 cases of A-chilles tendon insertion site injury.Wounds were repaired with lateral retromalleolar perforator flap,including 9 ca-ses of emergency repair and 8 cases of secondary operation.Patients with bony defect of the calcaneus were repaired using iliac crest bone graft,and patients with Achilles tendon insertion site injury received reconstruction.Results Of these flaps,16 survived completely,and 1 case failed for inefficient scavenge of hematoma formation under flap, resulting in blood circulation disorder and further local skin necrosis on the edge of flap,which was healed after the removal of stitches,drainage and other symptomatic treatment.All 17 patients were followed up for 6 months to 2 years,the appearance of the flap was satisfactory,indicating good healing of calcaneus and the stress resistance of A-chilles tendon.Additionally,walking function and sensation recovered well according to the score criterion of Marti hindfoot scale and Maryland foot score.Conclusion The clinical effect is satisfactory by applying lateral retromal-leolar perforator flap in repair of heel skin defect.