The musculocutaneous sural artery flap for soft-tissue coverage after calcaneal fracture

Soft-tissue defects following calcaneal fractures can be covered in a relat ively easy and safe procedure. We have modified the familiar distally based sural artery flap by lifting a part of the gastrocnemius muscle. With an i nferior pedicle, this musulocutaneous flap can be rotated onto the defect o n the sole of the foot and on the heel. Five patients with open fractures o f the calcaneus or wound necrosis after osteosynthesis were treated with th is procedure. Two defects were covered uneventfully, two flaps were prepare d, the rotation being done in a secondary procedure. One patient demanded f urther revisions, and the flap was partially lost, but the remaining defect was covered after open treatment. This new musculocutaneous sural artery f lap can be used for covering even an extensive defect after calcaneal fract ures and seems to be a reliable procedure. Morbidity at the donor site is l ow, and in the case of failure, the free flap remains an alternative.