Reverse sural fasciocutaneous flap for heel wounds. Crush injuries of the foot and heel can be devastating. As well as diabetic heel ulcers. In the past local wound care has been the treatment of choice with multiple debridements, application of wound gel and enzymatic debriding agents such as santyl. Even hyperbaric oxygen therapy has been used. While these are all good therapies it can take months to heal and that can be disastrous when one is trying to get back on their feet.

This brings to mind a recent motorcycle injury that came to my office. There was a crush injury of the heel due to a motorcycle crash and the heel started to turn black. The original treatment was to leave it alone and wait to see what happens. However this was a 30 year old that had a job on the line and could not risk being off his heel for months. He came to my office an after making sure he had good blood flow to his heel. He was taken to the operating room and a reverse sural fasciocutaneous flap procedure was performed.

The procedure is that i take a pedicle of tissue that is on the calf and very carefully dissect it out . I then prepare the heel wound for grafting by removing the dead tissue on the heel. Once that is all ready, I take the graft tissue from the calf while preserving the arteries and veins that are feeding that graft and rotate it down onto the heel. It is then sutured down to the heel and a wound VAC is applied to maintain a secure graft and that no hematoma should build up under it.

While this all may sound very complicated ( and it is) I have performed this procedure in San Diego and have had excellent results. The main take home point from this is, if you happen to have a crush injury from a fall or a motorcycle accident, don’t take ” lets wait and see approach” there are very reliable surgical techniques that can fix the problem with skin flap plastic surgery techniques such as reverse sural fasciocutaneous flap for heel wounds.