A Five- to Twenty-Year Follow-Up of Reconstruction of Heel and Plantar Surfaces

It is obvious that the soft tissue losses of the plantar surface and heel are different from other sites, so reconstruction of such tissues requires special consideration. Different procedures have been proposed and described by expert authors. The objective of this study was to compare these different procedures and the outcome of free flap transfer to these areas. All patients who had soft tissue losses of the plantar surface and heel were entered into the study. They were treated in Hazrat Fateme and Akhtar University hospitals by a team of 2 reconstructive surgeons, 2 general surgeons, and 2 nurses between 1982 and 2005. Patient ages were between 5 and 50 years. The initial injury was caused by mine explosions in almost 90% of patients. Flaps were raised conventionally and transferred to the recipient sites; microvascular procedures were performed for vessel anastomosis and some for nerve coaptation. Recovery of sensation was evaluated by light touch. The total number of free flap transfer was 108: 9 cases of mid-sole, 38 cases of forearm, 18 cases of sensory tensor fasciae latae flaps, and 43 cases of scapular and latissimus dorsi free flap transfer. All were followed up for at least 5 years.

The mid-sole donor provides the best free flap for small lesions, with the best sensory recovery by light touch and good durability with no shearing forces. The forearm flap was transferred for small lesions with good sensory recovery by light touch, but poor durability and high shearing forces. The sensory tensor fasciae latae flaps were transferred for large lesions which could not be covered by mid-sole and forearm free flaps, providing good sensory recovery and satisfactory durability, but high shearing forces. Scapular and latissimus dorsi free flaps had no sensory recovery, with very high shearing forces and the poorest durability. The donor site should be covered by skin grafting in tensor fasciae latae free flap transfer, but it can be closed primarily using latissimus dorsi and scapular free flap transfer.