Coverage of Loss of Substance from Heel : Sural Flap

Abstract

Introduction: The loss of skin tissue from the heel often poses a problem of coverage. The neurocutaneous flap of the sural nerve enriches the therapeutic arsenal in terms of management of these defects. The aim of our study is to better understand the operating technique, indications, advantages and disadvantages of this coverage process. Materials and Methods: We carried out a retrospective study of 30 cases of loss of skin tissue from the heel collected in the plastic and burn surgery department of the Nabeul University Hospital over the last ten years . Results: This study is composed of young adults with an average age of 32 years predominantly male, from which 9 are diabetic. The loss of tissue was located in a weight bearing area of the heel in 10 patients and in the posterior region in 20 patients. Etiology was traumatic in 20 cases dominated by bicycle spoke injuries. The average size of the skin substance loss was 40 cm² and the coverage was achieved with an average delay of 6 days, allowing to cover the Achille tendon in 15 patients and the calcaneus in 12 patients. The results were satisfactory, taking into account the function and aesthetic aspect of the flap. Conclusion: The sural flap is an attractive solution for heel coverage, especially the posterior unit because of its reliability, the lack of sacrifice of an important vascular axis, the ease of dissection and the low scar ransom.