ABSTRACT
BACKGROUND: The treatment of chronic calcaneal osteomyelitis remains a challenge for orthopedic and plastic surgeons. The basis of surgical therapy includes thorough debridement of infected tissue and reconstruction with well-vascularized flaps. METHODS: A "hybrid" sural flap composed of an adiponeurofascial flap proximally and a neurofasciocutaneous flap distally is described here. The adiponeurofascial flap was used to obliterate the bone cavity, and the distal part was used to resurface soft tissue defects. Five patients with chronic calcaneal osteomyelitis were treated with this modified sural flap. RESULTS: The size of the adiponeurofascial flap ranged from 5.0 × 4.0 cm to 13.0 × 5.0 cm, and that of the neurofasciocutaneous flap ranged from 6.5 × 3.0 cm to 6.0 × 8.0 cm. The donor defects were covered with skin grafts in three patients and closed primarily in two patients. All the flaps survived completely without any complications, the skin graft and the skin over the adiponeurofascial flap healed uneventfully. There was no evidence of recurrent infection during the follow-up period. CONCLUSION: The modified "hybrid" sural flap is simple and reliable and is a good candidate for treatment of chronic calcaneal osteomyelitis.
Subject(s)
Calcaneus/surgery , Osteomyelitis/surgery , Plastic Surgery Procedures/methods , Sural Nerve/transplantation , Surgical Flaps , Adult , Calcaneus/injuries , Calcaneus/pathology , Chronic Disease , Debridement , Fascia/transplantation , Humans , Male , Middle Aged , Osteomyelitis/pathology , Saphenous Vein/transplantation , Skin Transplantation/methods , Surgical Flaps/blood supply , Surgical Flaps/innervation , Treatment OutcomeABSTRACT
BACKGROUND: The sural neurofasciocutaneous flap has been widely used for reconstruction of soft-tissue defects in the lower leg, ankle, and foot. It can provide a large amount of tissue without compromising the function of the leg. The authors report the applications of the free peroneal perforator-based sural neurofasciocutaneous flap. METHODS: The free sural neurofasciocutaneous flap based on a single peroneal perforator is described. The peroneal perforator, which emerges from the posterior crural septum at the junction of middle and lower thirds of the fibula, was chosen as the pedicle of the flap. Six perforator-based sural neurofasciocutaneous flaps were transferred to resurface large soft-tissue defects in the upper limb. The size of the defects ranged from 15 × 6 cm to 45 × 10 cm. RESULTS: All six flaps survived completely without necrosis. The area of the flaps ranged from 16 × 8 cm to 30 × 10 cm. The average diameter of the peroneal perforator ranged from 1.0 to 1.5 mm, and the length of the perforator pedicles ranged from 4 to 6 cm. One patient developed arterial thrombosis after surgery, which was treated by removal of the thrombus and reanastomosis. No severe venous congestion was observed. All the patients were satisfied with the aesthetic outcome postoperatively at 3 to 12 months' follow-up. There were no serious donor-site complications. CONCLUSION: The free perforator-based sural neurofasciocutaneous flap is a good alternative for reconstruction of extensive soft-tissue defects in the upper limb.
