Effective method of treatment of tissular defects in calcaneal area. Case report

Abstract

Introduction: Infected tissue defects associated with impaired skeletal always presented treatement difficulties. Any new reconstructive technique aimed at reconstruction of these defects is welcome. Purpose: The aim was to describe a new reconstructive technique which proved to be effective in the treatment of septic tissular defects of calcaneal area associated with Achilles injury. Material and methods: The new type of perforator flap was for the first time used in a male patient, 20 years old admitted in the Septic and Reconstructive Surgery Department with a septic defect in the calcaneal area. The defect resulted from a car crash after avulsion of calcaneal tuberosity and injury of the Achilles tendon. The visible size of defects was 6x4 cm. Previously, in the patient was performed primary surgical debridement without bone and tendon stabilization. Three weeks after trauma in the patient was performed secondary debridement of necrotic tissues and reconstruction with tibial posterior corticoperiosteocutaneous perforator flap harvested by propeller techniques. Flap size was 25x5 cm. Bone graft incorporated in the flap was 4x1 cm. After rotation to 180⁰, the bone graft was fixed with a screw to calcaneus and the Achilles tendon was sutured to it. All this was performed in a single stage. Immobilization of the ankle was assured with plaster cast. Results: Postsurgical evolution of the flap was without major complications. A minor marginal venous congestion that didn’t endanger the flap was observed for several days after surgery and solved spontaneously. Plaster cast was removed at two months and the patient started to work actively with the ankle joint but without weight bearing. At three months after surgery at radiologic examination bone consolidation was put into evidence. Three months after reconstruction functional score LEM (Low Extremity Measure) was 87% and the patient was full weight bearing. At three months and a half the patient returned to his previous employment. Conclusions: Tibial posterior corticoperiosteocutaneous perforator flap proved to be effective for treatment of infected tissular defects in the calcaneal area with injury of Achilles tendon.