Total Heel Reconstruction with Throughflow Vascularized Fibula and Latissimus Dorsi Flap in Combination with an Instep Flap: A Case Report

Introduction: The total reconstruction of the heel is one of the most challenging and demanding procedures in foot reconstruction. Especially the problem of reconstructing a protective sensibility it’s very difficult to solve.

Methodology and Material: We want to present the case of a young woman, who lost her whole heel of left foot by a thermic injury with dry ice. We performed a staged reconstruction in a first operation with a vascularized fibula used as a throughflow fibula and a latissimus dorsi flap. A few months later we operated again on this case. To get a protective sensibility for the heel, we transposed the instep region of the foot to the heel.

Results: With this staged approach to the heel reconstruction we reached a successful result. The patient is able to walk shorter distances without walking canes without instability of the soft tissues of the heel.

Conclusions: The problem of a total heel reconstruction is only solved with staged operations. The combination of free flaps and pedicled flaps is the best option to get a satisfied result in these difficult cases.