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

Abstract

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 cm² to 22 × 10 cm², and the size of a muscle segment ranged from 6 × 3 × 1 cm³ to 10 × 3 × 2 cm³. 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.

Keywords: anterolateral thigh perforator flap; complex soft-tissue defects; double skin paddle; heel; reconstructive surgical procedures.

Figure 1

Schematic diagram of double skin paddle ALT flaps for complex heel defects. ALT, anterolateral thigh perforator.

Figure 2

(A) Large right heel defect following radical debridement; (B) double skin paddle ALT flap design; (C) elevating the double skin paddle ALT flaps showing the lateral femoral cutaneous nerve (yellow arrow); (D) postoperative view of the recipient site after 12 months. ALT, anterolateral thigh perforator.

Figure 3

(A) Right heel soft tissue defect with dead space following radical debridement; (B) chimeric double skin paddle ALT flap design; (C) harvesting of chimeric double skin paddle ALT flaps showing the lateral femoral cutaneous nerve (yellow arrow); (D) postoperative view of the recipient site. ALT, anterolateral thigh perforator.