Figure - available from: Plastic Surgery International
This content is subject to copyright. Terms and conditions apply.
Cadaveric dissection of lateral calcaneal flap, showing LCA (left) and small saphenous vein (SSV) (right).
Source publication
Lateral calcaneal flap is an established surgical option for coverage of lateral calcaneum and posterior heel defects. Lateral calcaneal flap vascularization and innervations are based on lateral calcaneal artery neurovascular bundle, that is, lateral calcaneal artery, small saphenous vein, and sural nerve. Anatomical research has allowed explorati...
Citations
... Lipatov K.V. et al. are the supporters of broadening the indications for free flaps application with microvascular anastomoses at the early stages after injury and explain their beliefs by the fact that the use of island tissue complexes as a plastic material for covering extensive wound defects increases the incidence of infection complications and nonunion of bone fragments [2,6,10,31,32,36,52,[66][67][68][69]. ...
... Revascularization of an autograft using microsurgical anastomoses requires appropriate magnifying equipment, specific instrumentation and what counts most is a qualified operating team, that will take years to prepare. Free microsurgical transfer of flaps from distant parts of the body is indicated for soft tissue defects of significant area, when it is impossible to use arealimited "island" flaps [2,4,6,12,15,17,23,31,32,40,41,53,54]. ...
... This situation aggravates the development of contracture of the affected segment joints, especially when a large soft tissue defect is located in functionally active areas, and deeper anatomical structures (bone fragments, peripheral nerves, tendons, joint capsules, etc.) are exposed. In this method of skin grafting, the newly formed skin has low mechanical strength, that almost completely excludes the technique application if the injury is located in the supportive area of the foot [2,5,10,16,24,32,36,51,64]. ...
peculiarity of the skin cover of the supporting zones is that the elastic fibers of the soft tissues of the plantar foot fix the skin to the deep fascia and the bone skeleton, resulting in minimizing of the supportive tissue mobility and increasing pressure stability without circulation disorder in areas of increased weight-bearing. Therefore, the requirements to the plastic properties of the selected material for the reconstruction of the soft tissues of the foot increase. Purpose is to review the various methods and techniques of surgical treatment for extensive soft tissue defects of the foot using flaps with an axial type of circulation. Material and methods The search of materials was performed from 2015 through 2020 in the following sources of information: eLibrary.ru; bibliographic bases (Scopus,; Web of Science); electronic library of dissertations of the Russian State Library (http://diss.rsl.ru) and sites of Dissertation Boards. The review of 72 publications of national and foreign authors related to this topic is presented. The depth of source selection was 16 years, starting from 2004. In the last 5 years, 45 studies data have been published. The literature related to surgical treatment of extensive defects in the foot soft tissues using complex flaps with an axial type of circulation supply was analyzed. Results Basing on the analysis of publications from various sources, the disadvantages and advantages of various methods and techniques of reconstructive plastic surgery are presented and various approaches and criteria for choosing the techniques of surgical soft tissues reconstruction are described. Conclusion In the treatment of patients with extensive soft tissue defects of the foot at the current stage of the reconstructive plastic surgery development, the doctrines based on microsurgical technologies of autografts of tissue complexes with an axial type of circulation became the most acceptable ways and techniques for lost skin restoration.
... 4 Distal pedicle flaps, including the reverse sural fasciocutaneous flap, 5,6 peroneal artery perforator flap, 7,8 lateral supramalleolar flap, 9 and distally pedicled peroneus brevis muscle flap, 10 can effectively repair the wound, but can hardly restore the satisfactory feeling. The proximal pedicle flaps, including the lateral calcaneal artery flap, [11][12][13][14][15][16][17] and the medial plantar flap, can effectively repair the wound and partially maintains the feeling, but the anatomical level remains to be much deeper and more complicated. ...
... Because there is no need for the dissection of the lateral calcaneal artery during the operation, this flap is different from that of the traditional lateral calcaneal flap. [11][12][13][14][15][16][17] This is more convenient to design, harvest, and transfer when compared with the lateral calcaneal flap. As long as the pivot point of the flap is designed between the point of 5 cm above the tip of the lateral malleolus and the tip of the lateral malleolus, the sural nerve or dorsolateral cutaneous nerve of the foot is projected in the dorsolateral surface of the foot. ...
Objective:
To investigate the clinical outcomes associated with repairing of small-sized wounds of Achilles tendon exposure with proximal pedicled cutaneous neurovascular flap in the dorsolateral foot.
Methods:
After thorough debridement, 16 cases with small-sized wounds of Achilles tendon exposure were repaired by proximal pedicled cutaneous neurovascular flap of the dorsolateral foot, and their clinical outcomes were observed.
Results:
All the flaps in the 16 cases survived completely, excluding the marginal part necrosis in 1 case, and all the wounds were healed. The 2-point discrimination of the flaps was 14.53 ± 1.55 mm (range, 12-17 mm) in patients without sural nerve injury after 3 to 18 months follow-up. No discomfort was felt in wearing normal shoes by all the 16 patients.
Conclusions:
It is reasonable to repair the small-sized wounds of Achilles tendon exposure with proximal pedicled cutaneous neurovascular flap of dorsolateral foot due to its effective repair of the wound, relatively uncomplicated surgery, and had satisfactory healing recovery.
The lateral calcaneal artery (LCA) flap is used for treating skin defects of the foot. We aim to study the relationship between the LCA and the Sural Nerve (SN) with the lateral malleolus (LM) to delineate the topographical landmarks for identifying LCA and SN while designing the LCA flap.
The foot was dissected to identify LCA and SN in 32 formalin-fixed lower limbs. The LCA and SN were identified and separated from the superficial fascia of the foot. Measurements such as the distance between the LCA and LM, SN and LM, and LCA and SN were taken in (a) horizontal plane, (b) 45º oblique plane passing, (c) vertical plane from the most prominent point on LM, including the luminal diameter of LCA.
In the horizontal plane, the LCA and SN were present at a mean distance of 24.56±5.2 mm and 22.64±6.26 mm from the LM, respectively. In a 45° oblique plane, LCA and SN were present at a mean distance of 29.10±6.12 mm and 22.68±7.05 mm from the LM, respectively. In the vertical plane, the SN was present at a mean distance of 26.59± 8.87 mm from the LM.
LCA was present in the horizontal plane and 45 oblique plane and was absent in the vertical plane in relation to LM; hence, the LCA flap should not extend beyond the 45 oblique plane, and the internal diameter of LCA should not be less than 1.02mm.
