2006 - UZ Leuven

defects.Adequate debridement, early soft tissue coverage, and adequatepostoperative care are necessary to achieve a good result. Bycombining different orthopaedic and plastic surgical techniques incombination with a adequate postoperative care, will lead to asignificant improvement of results and diminish the number ofamputations.HIERNER R., REYNDERS P., MATRICALI G.: Results of microsurgicalreconstruction at the heel. Chirurgica, 2006; 101: 19.Introduction: Soft tissue defects alone or in combination withunderlying bone defects at the heel lead to significant functionalimpairment of the foot. For reconstruction purpose, two differentfunctional subunits can be described at the heel such as, 1) dorsalheel subunit, and 2) the plantar heel subunit.Material and Methods: In a retrospective clinical study 18 patients withheel defects were examined. There were 11 male and 5 femalepatients. The age ranged from 4 – 79 years. Etiology of defect wastrauma (14), tumor (2) and pressure sore (2). Follow-up was at least 1year. The following criteria were examined: 1) type of treatment, 2)primary wound healing, and 3) complications.Results: In 2 patients with pressure sore at the heel treatmentconsisted of partial calcanectomy and secondary wound healing. In 16patient treatment was carried out using a pedicled (5 x plantarismedialis, 1x suralis) or a free (6 x Radial forearm flap, 2 x Scapulaflap, 2x latissimus dorsi muscle flap + skin graft) flap. Primary woundhealing was achieved in 13 patients with flap coverage. There wasone partial necrosis at the distal part of a suralis flap, which ultimatelywas treated by lower leg amputation. In two patients there wasincomplete fullthickness skin graft take at the donor site of an instepflap.Discussion: If ever possible the plantar subunit of the heel should bereconstructed with a sensible flap. The plantaris medialis flap turnedout of extreme value. For the dorsal subunit of the heel the pedicledsuralis flap offers an elegant treatment option. To improve hisreliability a delay procedure can be added. If no local flaps areavailable, the following points principles should be taken into account:Protective sensibility is coming from skin, aponeurosis plantaris, jointcapsules and periosteum; the larger the defect the more important ispostoperative physiotherapy and adequate orthopaedic shoeproviding. Fasciocutaneous flaps are indicated in partial defect,complete heel defects are best treated by a muscle flap coved bysplitthickness skin graft. Secondary operation are always necessary toimprove the functional and/or aesthetic result or to treat secondary83