Resurfacing Weight Bearing Areas of the Heel

ABSTRACT

Five cases of chronic ulceration following skin graft resurfacing of the weight bearing surface of the heel are presented. All were managed with debridement and coverage with a free innervated dorsalis pedis tissue transfer. The technical refinements that have contributed to the reliability of the flap include careful distal identification of the first dorsal metatarsal artery (FDMA) and division of the dorsalis pedis artery (DPA) under direct vision below the takeoff of the FDMA. Donor site morbidity has been minimized by taking care to preserve the extensor paratenon as a bed for the subsequent skin graft and by immobilization of the donor foot with plaster and bed rest for 10 days. Four of the patients were followed for 2, 4, 4, and 6 years; one was lost to follow-up. All were active with protective sensation in their flaps. No instances of flap breakdown and no significant donor site morbidity were noted. The dorsalis pedis innervated free tissue transfer is recommended as a reliable procedure for resurfacing weight bearing areas of the foot when simpler methods have failed.