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A modified perforator-based stepladder V-Y advancement flap in the Achilles tendon area for coverage of larger posterior heel defects

  • Author Footnotes
    1 These two authors contributed equally to this work.
    Hai-Hua Huang
    Footnotes
    1 These two authors contributed equally to this work.
    Affiliations
    Department of Wound Repair; Institute of Wound Repair and Regeneration Medicine, Southern University of Science and Technology Hospital, Southern University of Science and Technology School of Medicine, Shenzhen,Guangdong, 518055, China
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  • Author Footnotes
    1 These two authors contributed equally to this work.
    Ze-Yong Wu
    Footnotes
    1 These two authors contributed equally to this work.
    Affiliations
    Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong,524001, China.
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  • Xiu-Feng Chen
    Affiliations
    Department of Gastroenterology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524001,China.
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  • Yu-Cang Shi
    Affiliations
    Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong,524001, China.
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  • Shu-Hao Xu
    Affiliations
    Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong,524001, China.
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  • Sui-Jiang Wang
    Correspondence
    Corresponding author: Sui-Jiang Wang, Department of Plastic and Reconstructive Surgery, No.466. Xingangzhong Road, Haizhu District, Canton of Guangdong province, 510317,China
    Affiliations
    Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital,Guangzhou,Guangdong, 510317,China
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  • Yue-Sheng Huang
    Correspondence
    Corresponding author: Mr. Yue-Sheng Huang, Department of Wound Repair, Southern University of Science and Technology, No.6019. Liuxian Avenue, Nanshan District, Shenzhen, Guangdong, 518055, China
    Affiliations
    Department of Wound Repair; Institute of Wound Repair and Regeneration Medicine, Southern University of Science and Technology Hospital, Southern University of Science and Technology School of Medicine, Shenzhen,Guangdong, 518055, China
    Search for articles by this author
  • Author Footnotes
    1 These two authors contributed equally to this work.
Published:November 22, 2022DOI:https://doi.org/10.1016/j.bjps.2022.11.009

      Abstract

      Background

      Posterior heel defect coverage is a challenge because of the paucity of suitable flaps. The traditional local stepladder V-Y advancement flap is indicated only for small defects due to the lack of an axial pedicle. This study reports our experience with the use of perforator-based stepladder V-Y advancement flaps in larger posterior heel defect repair.

      Methods

      Twenty-two patients with posterior heel defects were treated with modified perforator-based stepladder V-Y advancement flaps in the Achilles tendon area for 11 years. Sixteen males and 6 females aged 3-74 years underwent surgery. The defect size, perforator characteristics, flap size, flap movement, sural nerve, lesser saphenous vein, deep fascia, flap survival, and outcome quality were analysed.

      Results

      The perforators were found to predominate within two 2-cm intervals: 0-2 cm and 4-6 cm proximal to the tip of the lateral malleolus. Twenty-one perforator-based flaps healed uneventfully, and only one developed tip necrosis on the lower edge, which healed by secondary intention. The maximum distance of distal movement was 5.0 cm for the modified flap, in contrast to 2.5 cm for the traditional flap. All flaps allowed adequate and durable reconstruction to be achieved, with excellent contouring after 2-28 months of follow-up.

      Conclusions

      The perforator-based stepladder V-Y advancement flap resulted in good outcomes for larger posterior heel defects compared with conventional transfer methods. The flap is a reliable, well-vascularized, sensate and pliable local flap option that uses similar tissue from adjacent skin for defect repair and creates an internal gliding surface for the Achilles tendon.

      Key Words

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