Proximally-Based Sural Adipose-Cutaneous/Scar Flap in Elimination of Ulcerous Scar Soft Tissue Defect Over the Achilles Tendon and Posterior Heel Region
Scar ulcers that spread over the Achilles tendon and posterior heel disturb patients by causing pain, impeding hygiene, and creating difficulty in finding appropriate shoe wear. This region naturally endures pressure, so effective reconstruction is based on flap use. The most popular flaps currently used are distally-based sural fascial-cutaneous flaps, calcaneal artery skin flaps, and free flaps. These flaps, however, are insensate, can create soft-tissue excess, and cause donor site morbidity. Ulcerous soft-tissue defects over the Achilles tendon and posterior heel after burns, frost, and trauma were studied and reconstructed using proximally-based sural adipose-cutaneous flap, the anatomy of which was studied on the lower extremities of cadavers. The technique and outcomes are presented in this chapter.