Selection of Alternative Flaps in Post-traumatic Posterior Heel Soft Tissue Defect Reconstruction -

We present a management, of posttraumatic posterior heel defects through a study carried out in 50 cases from January 1995 to January 2008 at the Plastic and reconstructive and Orthopedic – traumatology Clinic of the University Clinic Center Sarajevo. Isolated injuries (injuries only over the posterior heel) were present in 39 patients (78%) and combined injuries (injuries to posterior heel and surrounding regions) in 11 patients (22%) Patient’s data including age, sex, side of injury, mode of injury, extent of injury (isolated or combined), if combined whether involving the weight-bearing part of heel, type of wound, management of wound, wound healing time and complications were noted. Criteria that were used for the selection of method of reconstruction in our study are; size of defect, location of the defect, complexity of the injury i.e. exposed bone or tendoachilles, extent of the zone of trauma. Pre-operative Doppler study was done in all patients. We covered these with various flaps depending upon the defect size, its exact location, associated injuries, extent of zone of trauma, and complexity of the defect. The aim was to select the most suitable method for soft tissue coverage for posterior heel reconstruction. On long-term follow-up of the patients, we did not find any recurrent ulceration in the patients having isolated posterior heel injuries. In patients having combined injuries, two in which cross-leg flap was done, patients had episodes of trophic ulceration that were treated with conservative management with dressings and modification of footwear.