Reconstruction of ankle and heel defects by a modified wide-base reverse sural flap

Background: Flap reconstruction around the ankle and heel is a technically demanding procedure. Some patients have contraindications for microsurgery, however, limiting the options fur local tissue transfer. In this study, we describe our experience with a new flap technique for ankle and heel cover age. Methods: We designed a modified wide-base reverse sural flap and applied it to 20 patients with lower leg trauma From 1994 to 1997. All patients susta ined Gustilo type IIIb,c open fractures with soft-tissue defects around the ankle and heel, Six cases had chronic osteomyelitis. Most of our patients had contraindications for microsurgery such as old age, poor medical condit ion, or heavy smoker status. The average age was 69.5 years old, and the av erage follow-up time was 18.5 months. Results: All 20 patients underwent successful modified re-verse sural flap reconstruction. There were no deep infections, no soft-tissue necrosis, or pressure ulcers, The nonunion rate was 5%. The average time for flap elevat ion and rotation was 29.3 minutes. No blood transfusion was required. An un sightly scar was the major complaint (60%) from our patients. Seventeen cas es (85%) achieved good functional outcomes. Conclusion: This report demonstrates that our design of this modified wide- base reverse sural flap is suitable for flap reconstruction around the ankl e and heel; especially for patients who have difficulty in receiving micros urgery, The surgical procedure is simple, and the results are satisfactory.