Distal posterior tibial artery perforator flaps for the management of calcaneal and Achilles tendon injuries in diabetic and non-diabetic patients

Abstract

Management of Achilles tendon and heel area defects is a common challenge for the reconstructive surgeon due to the lack of soft tissue availability in that region. In this article, we present our experience in covering these defects by using the distal perforator propeller flaps based on the posterior tibial artery. Perforator flaps are based on cutaneous, small diameter vessels that originate from a main pedicle and perforate the fascia or muscle to reach the skin. Their development has followed the understanding of the blood supply from a source artery to the skin. Six patients (five males and one female) underwent reconstruction by using the posterior tibial artery distal perforator flap for covering defects in the distal Achilles tendon region in patients with and without diabetes mellitus. Postoperative complications included a hypertrophic scar formation in one patient, partial marginal flap necrosis in another patient, and a wound infection in a third patient. All wounds were eventually healed by the last postoperative visit. In conclusion, perforator flaps based on the distal posterior tibial artery may be a reliable option for the coverage of small to moderate size defects of the Achilles tendon and heel area regions.

Keywords: Achilles tendon; diabetes; flaps; plastic surgery; reconstructive foot surgery.

Fig. 1

Intra-operative picture showing the raising of the posterior tibial artery perforator flap (a), insetting at about 45° rotation (b, c), and final postoperative outcome (d).

Fig. 2

Intra-operative picture showing the raising of the posterior tibial artery perforator flap (a), insetting at about 90° rotation (b, c), and final postoperative outcome (d).

Fig. 3

Intra-operative picture showing the raising of the posterior tibial artery perforator flap (a), insetting at about a180° rotation (b, c), and final postoperative outcome (d).