Süleyman Çeçen, Kaan Kavruk, Selçuk Akın
Turkish Journal of Plastic Surgery - 2025;33(4):188-190
Despite significant advances in perforator flap surgery, soft-tissue defects of the heel still remain challenging. The main challenge points are obtaining proper reconstruction of such deficiencies with adequate function and form of the heel with reasonable donor-site morbidity in this area with skin shortage. The resurfaced heel is expected to withstand shearing and load-bearing forces. The densely adherent, glabrous skin of the heel makes functional replacement difficult and has essential contours that are critical for proper shoe-fitting. Diverse techniques have been employed to reconstruct this area, such as the sural flap, stepladder V-Y advancement flap, lateral and medial calcaneal artery flap, medial plantar artery flap, and numerous free flaps.[1-4] Due to these factors and the close vicinity of the suitable recipient vessel, the utilization of various free flap options may become appealing. Nevertheless, the selection process for a flap may be constrained by the requirement for one that possesses an adequate thickness and provides sufficient coverage. A 21-year-old male patient presented to our clinic with a nonhealing wound on his right heel that had persisted for approximately 3 years. The patient had initially sustained a suspected fracture of the right foot following a bicycle accident 3 years ago, which led to the application of a splint. Subsequently, he developed severe pain and swelling, resulting in compartment syndrome in the right lower extremity. Reconstructing wounds on the heel can be a challenging task due to the unique characteristics of the area. The skin in this region is thin and must withstand high-stress forces, making it challenging to find appropriate options. In addition, using local and regional options may not be feasible due to previous trauma and surgery, limiting the availability and mobility of adjacent tissues. In such cases, microvascular tissue transfer procedures may be necessary. We suggest the superior lateral genicular artery perforator (SLGAP) flap as a suitable option. This flap is thin and flexible and has an adequate pedicle length and calibration.
