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The most important requisite in the care of ulcers in the heel region is replacement skin cover with adequate sensation.
The dorsalis pedis flap appears adequate, but the anterior subcutaneous approach gives a pedicle of inadequate length to enable the flap to reach the most important posterior weight-bearing area. It was therefore decided to short-circuit the course of the pedicle by passing the whole flap through the interosseous membrane between the tibia and the fibula to enable the flap to reach the weight-bearing area without tension.
After 10 meticulous cadaver and two post-traumatic limb dissections with angiographic confirmation, it appeared that such a flap was feasible and would satisfy all basic requirements. Clinically this technique was tried in two patients who were provided with sensate, well padded skin cover for the whole of the heel region.
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- Use of an innervated skin graft to provide sensation to the reconstructed heel.Plastic and Reconstructive Surgery. 1978; 62: 157
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Accepted: October 21, 1986
Received: July 21, 1986
© 1987 The Trustees of British Association of Plastic Surgeons. All rights reserved. Published by Elsevier Inc.