Heel reconstruction using a combination of free sensate medial plantar flap and skin graft: A case series

Managing soft tissue defects in the heel presents a significant challenge for surgeons due to the heel's crucial role in weight-bearing. A free instep flap with end-to-side nerve coaptation offers an effective solution for reconstructing large heel defects. Four patients were referred to our hospital with soft tissue lesions in the weight-bearing heel and instep area. Their heels were reconstructed using a free instep flap harvested from the opposite foot. In three cases, an end-to-side arterial anastomosis was performed. In the fourth case, due to a midfoot amputation, an end-to-end arterial anastomosis was performed more distally to preserve collateral branches. In all cases, the vein was anastomosed end-to-end to the posterior tibial vein. The epineurium of the medial plantar nerve was opened, and an end-to-side nerve repair was performed. Our patients demonstrated satisfactory sensation, and none experienced flap shearing or ulceration. The flap thickness and shape were ideal, closely resembling the contralateral normal side.