Off-Loading Large Posterior Heel Defects After Sural Artery Soft-Tissue Flap Coverage With a Stacked Taylor Spatial Frame Foot Plate System

Soft-tissue reconstruction of large posterior heel ulcerations represents a formidable challenge because of the specialized nature of the tissues; relatively immobile surrounding tissues; proximity to underlying tendon, bone, and neurovascular tissues; and limited soft-tissue flap procedures available. The sural artery flap has been shown to be reliable, relatively simple to perform, to preserve major arteries, and to afford durable soft-tissue coverage of large soft-tissue defects about the posterior and plantar heel. However, a common problem during the postoperative recovery period for sural artery flaps has been preventing pressure over the flap, pedicle, and donor site that come in direct contact with the supporting surfaces as the patient remains immobilized. The use of external fixation devices to elevate the lower limb and foot is not new; however, current designs are difficult to construct, relatively unstable, do not allow weightsharing, and can not be used to concomitantly reconstruct underlying osseous deformities. In this report, the authors’ present their technique for performing the sural artery flap and introduce the use of a stacked Taylor Spatial Frame foot plate external fixation device as an alternative to the more cumbersome piecemeal systems described in the literature. This technique has the unique features of affording increased stability, ease of application, and ability to perform concomitant osseous surgery, in addition to allowing for weightsharing according to the individual patients needs while completely relieving pressure from the entire lower leg, ankle, and heel and allowing easy access to the flap, pedicle, and donor site for frequent monitoring and dressing.

Keywords:  heel ulceration , sural artery flap , off-loading techniques , external fixation , Taylor Spatial Frame