Sural nerve nutrient vascular flap in treatment of heel soft tissue defect in children

Objective To investigate the clinical effect of the reversed sural nerve nutrient vascular flap for repair of pediatric heel soft tissue defect. Methods From December 2009 to December 2012, heel soft tissue defects of eleven children were repaired with the reversed sural nerve nutrient vascular flap. All pediatric wounds were debrided in emergency.The injuries of blood vessels, nerves or Achilles tendon in the wound were repaired at first. Among them 6 children with heel soft tissue defects were repaired with reversed sural nerve nutrient vascular flap in emergency. And 5 children with heel soft tissue defects were covered with vacuum sealing drainage(VSD) in emergency, then the defects were repaired with reversed sural nerve nutrient vascular flap in the second phase after VSD. Results Those patients were followed up for about 6 to 24 months after operation, an average follow-up time was 12 months, a total of 11 sural nerve nutrient vascular flaps completely survived after transplantation, texture and color of flap were fine. All flaps did not show cyanoderma, swelling, stiffness and so on. The stitches of wound were taken out after transplantation 10 to 12 days, the wounds without second infection. All graft skins on donor area survived, and wounds were healed with good appearance. At the time of the last follow-up, the shape of those flaps was satisfactory, the textures were perfect, and appearances were not obese, sensation recovered from S3 to S4. The appearance and function of limb were satisfactory. AOFAS ankle score was excellent, function of foot returned to normal or near normal. Conclusion Most pediatric heel tissue defects are associated with rupture of Achilles tendon or fracture of calcaneal. The reversed sural nerve nutrient vascular flap can be used torepair heel soft tissue defects, which could prevent dysfunction of limb in children.