Tuesday, February 4, 2020

Lateral Heel Defect - Exposed Calcaneum covered with Lateral calcaneal Artery Flap

Lateral heel defect with exposed calcaneum - How to Manage in a child?

Its always a challenge to cover a defect over the lateral calcaneum when its exposed , especially in a child. This case is a 7yr old boy who had an RTA with Deep Abrasion over the Lateral calcaneum region, for which he was managed with dressing as usual but after one-week skin got discolored and debridement was done and now the challenge to cover the raw area after debridement since calcaneum was exposed.

Exposed Calcaneum

Flap Cover planned - Lateral Calcaneal Artery Flap

Finally, its the Lateral calcaneal artery flap that is planned over the defect with L*B Proportions taken, and then the flap is marked adjacent to the lateral malleolus. Pre-op doppler to mark the LCA pattern is done. The flap has to be transposed over the defect. this case had a dog ear at the base of the flap after inset, which was managed with an SSG. 

Then the donor site is always covered with SSG. A drain tube is kept to avoid hematoma. The graft is secured with bulky dressing and a window is kept for the flap to be monitored. usually, tip necrosis is avoided if too tight insert is not given. ideally, allow the raw area to shrink in size before proceeding with the flap cover so that to avoid going beyond the reach of the flap dimensions.

Lateral calcaneal Artery Flap