Comparison of V-Y Advancement Flap with Reverse Sural Flap for Coverage of Posterior Heel Soft Tissue Defects
DOI:
https://doi.org/10.70749/ijbr.v3i6.2483Keywords:
Posterior heel defects, V-Y advancement flap, Reverse sural flap, Soft tissue reconstruction, Flap necrosisAbstract
Background: Soft tissue defects of the posterior heel are difficult to manage due to high pressure load, limited local tissue, and frequent exposure of vital structures. Objective: To compare the outcomes of V-Y advancement flap and reverse sural flap for coverage of posterior heel soft tissue defects. Methodology: This randomized controlled trial was conducted at the Department of Plastic Surgery, Shaikh Zayed Hospital, Lahore, from November 2024 to April 2025. Sixty patients aged 14–60 years with posterior heel soft tissue defects were enrolled and randomized into two groups (n=30 each). Group A underwent reverse sural flap, while Group B received V-Y advancement flap. Results: The mean operative time was significantly longer in Group A (96.2 ± 14.8 min) compared to Group B (72.5 ± 11.3 min; p < 0.001). Flap necrosis occurred in 5 patients (16.7%) in Group A versus 1 patient (3.3%) in Group B (p = 0.04). Donor site disfigurement was observed in 20.0% of Group A patients but in none of Group B (p = 0.01). Other complications such as flap dehiscence, edema, congestion, and infection were more frequent in Group A but not statistically significant. By day 14, satisfactory wound healing was achieved in 86.7% of Group A and 96.7% of Group B patients (p = 0.16). Conclusion: Both flaps are effective for posterior heel reconstruction. The V-Y advancement flap offers shorter operative time, lower necrosis rates, and superior donor site cosmesis, making it preferable for small to moderate defects. The reverse sural flap remains valuable for larger or more complex heal wounds.
Downloads
References
1. Krishna D, Chaturvedi G, Khan MM, Cheruvu VPR, Laitonjam M, Minz R. Reconstruction of Heel Soft Tissue Defects: An Algorithm Based on Our Experience. World J Plast Surg. 2021 Sep;10(3):63-72. PMID: 34912668; PMCID: PMC8662685.
https://doi.org/10.29252/wjps.10.3.63.
2. Mehmood Hashmi P, Musaddiq A, Hashmi A, Zahid M. Comparison of distally based sural artery and supramalleolar flap for coverage of dorsum of foot and ankle defects; a cross-sectional study of 53 patients. Ann Med Surg (Lond). 2021 Dec 4;73:103109. PMID: 34917350; PMCID: PMC8669369.
https://doi.org/10.1016/j.amsu.2021.103109.
3. Jaiswal KS, Gupta S, Goil P, Mohammad A, Gupta P. Empirical Evidence on the Reliability of Lateral Supramalleolar Flap over Reverse Sural Flap for Local Soft Tissue Coverage of Dorsum of the Foot and Ankle Defects. Indian J Plast Surg. 2023 Feb 21;56(2):159-165. PMID: 37153338; PMCID: PMC10159700.
https://doi.org/10.1055/s-0043-1760828.
4. Nguyen TN, Mai TT, Vo KH, Nguyen AV, Nguyen AN, Cao T. Foot and Ankle Reconstruction Using Retrograde Lateral Supramalleolar Flap. Indian J Plast Surg. 2024 Sep 3;57(Suppl 1):S80-S87. PMID: 39741711; PMCID: PMC11684909.
https://doi.org/10.1055/s-0044-1788991.
5. Oon ZS, Kow RY, Ahmad Alwi AA, Ayeop MAS, Low CL, Che Ahmad A. The Role of Medial Plantar Artery Flap in Heel Pad Reconstruction: A Report of Two Cases. Cureus. 2023 Jul 13;15(7):e41844. PMID: 37575710; PMCID: PMC10423084.
https://doi.org/10.7759/cureus.41844.
6. Feng B, Dai GM, Wang YJ, Zhang L, Niu KC The Treatment Experience of Different Types of Flaps for Repairing Soft Tissue Defects of the Heel.
https://doi.org/10.2147/ijgm.s329642
7. Beecher SM, Cahill KC, Theopold C. Pedicled sural flaps versus free anterolateral thigh flaps in reconstruction of dorsal foot and ankle defects in children: a systematic review. Arch Plast Surg. 2021;48(04):410-6.
https://doi.org/10.5999/aps.2020.00983
8. Yang X, Fang Z, Liu M, Zhang Y, Chen Q, Tao K, et al. Reconstruction of deep burn wounds around the ankle with free fascia flaps transfer and split-thickness skin graft. J Burn Care Res. 2019;40(6):763-8.
https://doi.org/10.1093/jbcr/irz078
9. Saaiq M, Zimri FUK. Reverse Flow Superficial Sural Artery Fasciocutaneous Flap: A Comparison of Outcome between Interpolated Flap Design versus Islanded Flap Design. World journal of plastic surgery. 2019;8(3):316-23.
10. Bakhsh K, Zimri FK, Mohammad E, Atiq Ur R, Saaiq M. Presentation and outcome of femoral infected non-unions in children and adolescents. Pakistan journal of medical sciences. 2021;37(1):201-.
https://doi.org/10.12669/pjms.37.1.3354
11. Stepladder V-Y advancement flap for repair of postero-plantar heel ulcers Author links open overlay panelA. Hayashi MD (Assistant Professor), Y. Maruyama MD. Plantar reconstruction using a step-ladder advancement flap Author links open overlay panelG.
12. Furubayashi, M. Sawaizumi, T. Maeda, K. Tanakura.Repairs of the heel Br J PLast Surg(1961P). A comparative study of the reverse sural fascio-cutaneous flap outcomes in the management of foot and ankle soft tissue defects in diabetic and trauma patients. Foot Ankle Special. 2019;12(5):432-
13. Ziani F, Rubino C, Rampazzo S, Tettamanzi M, Arrica G, Ginatempo I, Trignano C, Santanelli di Pompeo F, Sorotos M, Trignano E. Microsurgical reconstruction of the heel: evaluation and decision-making recommendations based on a case series. Case Reports Plast Surg Hand Surg. 2025 Sep 5;12(1):2556491. PMID: 40927057; PMCID: PMC12416009.
https://doi.org/10.1080/23320885.2025.2556491.
14. Grauberger JN, Gibreel WO, Moran SL, et al. Long‐term clinical and patient‐reported outcomes in free flap reconstruction of the weight‐bearing heel pad and non‐weight‐bearing Achilles tendon regions. Microsurgery. 2020;40(8):835–845.
https://doi.org/10.1002/micr.30658.
15. Chellamuthu A, Jayaraman SK, A RB.. Outcome analysis comparing muscle and fasciocutaneous free flaps for heel reconstruction: meta-analysis and case series. Indian J Plast Surg. 2023;56(1):13–21.
https://doi.org/10.1055/s-0042-1760093.
16. Nazerani S, Nazerani T, Keramati MR.. Plantar skin defect reconstruction: a large series with a 15-year follow-up. Int J Low Extrem Wounds. 2022;21(4):632–639.
https://doi.org/10.1177/1534734620983519
17. Surgical management of a mangled foot by a free vascularized fibular graft: a case report. Kow RY, Ahmad Alwi AA, Abdul Aziz A, Abas MF, Low CL. IeJSME. 2018; 12:30–33.
https://doi.org/10.56026/imu.12.2.30
18. Heel pad reconstruction with medial plantar flap. Langat AS, Wan Sulaiman WA, Mat Johar SF. Cureus. 2021;13:0.
19. Feng B, Dai GM, Wang YJ, Zhang L, Niu KC. The Treatment Experience of Different Types of Flaps for Repairing Soft Tissue Defects of the Heel. Int J Gen Med. 2021 Nov 18;14:8445-8453. PMID: 34819752; PMCID: PMC8608019.
https://doi.org/10.2147/IJGM.S329642.
20. Opoku-Agyeman JL, Allen A, Humenansky K. The Use of Local Medial Plantar Artery Flap for Heel Reconstruction: A Systematic Review. Cureus. 2020 Aug 19;12(8):e9880. PMID: 32963919; PMCID: PMC7500739.
https://doi.org/10.7759/cureus.9880.
21. Ali H, Adil F, Idrees F. Reverse flow sural flap; a versatile method for the management of soft tissue defects of dorsum of foot, ankle and heel. Professional Med J 2019; 26(1):7-13.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
