THE NEWTON MEDIAL CALCANEAL ARTERY FLAP DAVID GITLIN DPM E . DOUGLAS NEWTON MD KEVIN WARNER DPM CAMILO BENITEZ DPM

FIGURE 1 FIGURE 2 FIGURE 3 FIGURE 4 FIGURE 5 FIGURE 6 FIGURE 7

STATEMENT OF PURPOSE: PROCEDURES: RESULTS: Closure of large soft tissue defects of the Preoperatively a doppler is used to map out the vessels to Six heel pad advancement flaps have been performed, and all have healed foot and ankle can be a significant challenge assess if there is a viable medial vascular source. Angiogram with just minor complications during the postop process that required for the foot specialist. The purpose of this mapping can also be performed. First a thorough sharp minimal care. Post op course is strict non weight bearing. Total follow up study is to describe a specific type of wound debridement of the wound is performed. The flap is now was 18 months. closure involving a medial calcaneal artery planned with the lateral and medial incisions at the glabrous flap that to our knowledge, has not been junctions of the heel. The tourniquet is inflated to provide a DISCUSSION: It is understood that in the field of plastic surgery that when described in current literature. To date six bloodless field and flap dissection begins at the lateral aspect it comes to skin coverage the best option is using the skin next to the of these heel pad advancement flaps have of the heel while cauterizing any bleeding vessels as the flap wound itself. This is most important in the plantar foot where specialized been performed. FIGURE A elevation progresses. The deep fascial plane of dissection is glaborous skin is unique for its shear and pressure resisting properties. METHODOLOGY: at the plantar calcaneus: the bone as well as plantar fascia Anatomy of the plantar foot is essential when performing this particular Previous literature review done on calcaneal origin must be visualized. The medial heel pad must be flap. The heel pad is vascularized on the medial side by the medial artery flaps have been described in the dissected carefully and the medial pedicle identified. The calcaneal arteries provided by the lateral plantar artery. The first medial literature by W. Grabbe MD. This includes a medial skin overlying the vascular pedicle is kept intact and calcaneal branch may emanate from the end of the posterior tibial artery small fascio-cutaneous rotational flap based the flap is now advanced distally to cover a significant midfoot as well. The lateral aspect of the heel is supplied by the posterior on the vasculature of the lateral calcaneal wound. This leaves a deficit posteriorly on the heel which is peroneal or the posterior tibial artery. We have not yet used the heel pad artery. in a non weight bearing area. This can be covered with a split flap as an island pedicle flap even though a potential for this exists given thickness or full thickness skin graft. We have also let this the length of the vessels that can be safely developed. Based on results area granulate in by secondary intention or with use of a from the six cases performed, this flap provides a valuable option for FIGURE B vacuum assisted closure device. coverage of difficult midfoot wounds of the foot.