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

Huang, Hai-Hua1; Wu, Ze-Yong2; Chen, Xiu-Feng3; Shi, Yu-Cang2; Xu, Shu-Hao2; Wang, Sui-Jiang4,5; Huang, Yue-Sheng1,6

2023-02-01

10.1016/j.bjps.2022.11.009

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY   Impact Factor & Quartile

1748-6815

1878-0539

Background: Posterior heel defect coverage is challenging because of the paucity of suitable flaps. The traditional local stepladder V-Y advancement flap is recommended only for small defects because of the lack of an axial pedicle. This study reports our experience of using the perforator-based stepladder V-Y advancement flaps in a 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 six 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 analyzed.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 con-trast 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.(c) 2022 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.

The Achilles tendon area Skin flap Perforator Posterior heel Stepladder V-Y advancement flap

SCI

English

First ; Corresponding

Surgery

Surgery

WOS:000987126700001

ELSEVIER SCI LTD

Web of Science

1.Southern Univ Sci & Technol, Southern Univ Sci & Technol Hosp, Inst Wound Repair & Regenerat Med, Dept Wound Repair,Sch Med, Shenzhen 518055, Guangdong, Peoples R China
2.Guangdong Med Univ, Dept Plast Surg, Affiliated Hosp, Zhanjiang 524001, Guangdong, Peoples R China
3.Guangdong Med Univ, Dept Gastroenterol, Affiliated Hosp, Zhanjiang 524001, Guangdong, Peoples R China
4.Guangdong Second Prov Gen Hosp, Dept Plast & Reconstruct Surg, Guangzhou 510317, Guangdong, Peoples R China
5.Dept Plast & Reconstruct Surg, 466 Xingangzhong Rd, Haizhu Dist 510317, Canton Guangdon, Peoples R China
6.Dept Wound Repair, 6019 Liuxian Ave, Shenzhen 518055, Peoples R China

Huang, Hai-Hua,Wu, Ze-Yong,Chen, Xiu-Feng,et al. A modified perforator-based stepladder V-Y advancement flap in the Achilles tendon area for coverage of larger posterior heel defects[J]. JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY,2023,77.

Huang, Hai-Hua.,Wu, Ze-Yong.,Chen, Xiu-Feng.,Shi, Yu-Cang.,Xu, Shu-Hao.,...&Huang, Yue-Sheng.(2023).A modified perforator-based stepladder V-Y advancement flap in the Achilles tendon area for coverage of larger posterior heel defects.JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY,77.

Huang, Hai-Hua,et al."A modified perforator-based stepladder V-Y advancement flap in the Achilles tendon area for coverage of larger posterior heel defects".JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY 77(2023).