RECONSTRUCTION OF HIND FOOT DEFECTS;

A SIMPLIFIED WORKABLE SOLUTION

Abstract

BACKGROUND: Reconstruction of traumatic as well as non-traumatic hind foot defects is always a challenging task. We
share here a simple and practical protocol (working solution) to select the most suitable method for soft tissue coverage of hind foot
defects, customizable for every patient. METHODS: We carried out this study, in our department on 75 cases from March 2009 to May
2012. All cases with wound/defect in hind foot area were included. Majority of cases were traumatic rest included cases of malignancy,
Trophic ulcers, infection. Patient's data including age, sex, site of injury, mode of injury, extent of injury (isolated or combined), if
combined structures involved, type of wound, management of wound, wound healing time and complications were noted. Once optimal
wound conditions were achieved the best possible reconstructive option was selected. The various reconstructive options include VAC
therapy, Skin graft, local transposition flap, perforator based flapspedicled faciocutaneous/ muscle flaps, intrinsic foot muscles, Medial
plantar artery flap and distant flaps like cross leg flap and micro vascular free flaps. RESULTS: All patients had satisfactory and stable
reconstruction. They were ambulating freely by 4-6 weeks post operatively. There were few complications like patchy graft loss,
peripheral flap necrosis, flap congestion, but none was serious and did not require repeat surgery. CONCLUSION: The simplified protocol
followed by us is a practical customizable solution for difficult task of hind foot reconstruction. The choice of one or multiple techniques
will vary from time to time from one surgeon to another depending upon his or her experience and liking.