Publication:

Reconstruction full-thickness defect of calcaneus post trauma using sural fascio-cutaneous flap: a case report

Traffic accidents often cause degloving injuries to the extremities that can cause an avulsion of the skin. Injuries of the feet and lower legs require special management, specifically the calcaneus region, which is an anatomical challenge for reconstructive surgery. The sural flap is often used for calcaneus defect reconstruction. This method provides more volume compared to skin graft methods. We report the case of a 33-year-old woman who was injured in a motorcycle accident. The patient had a wound on the calcaneus about 8 cm×3 cm long, just below the medial malleolus. The wound is circular, leaving intact tissue as a pedicle with a plantar pedis measuring 3 cm×2×cm×1 cm. The patient underwent debridement with a sural flap. Follow-up post-surgery, the flap was viable, but other procedures (casting, in setting flap, and refinement flap) are still needed to achieve better outcomes and physiotherapy to restore function. Degloving injuries generally cause devascularization. In cases like this, debridement is used as the initial therapy to preserve the surrounding soft tissue and skin. The second treatment is to prevent contractures. Most surgeons recommend a skin graft in the first stage. We performed a flap that has a rapid reconstruction process and can prevent the risk of skin necrosis as a weight-bearing area. Due to the existence of a long, retractable vascular pedicle, the sural flap is a helpful treatment in the reconstruction of skin defects in the distal area of the lower extremity. Reconstruction using fasciocutaneous flap procedure, for the patient's lower extremity defect (calcaneal defect) was successful. In trauma cases that cause damage full full-thickness skin and soft tissue, it is advisable to perform a flap as one of the reconstructive surgery procedures to restore the best function and shape of the involved lower extremity.