The application of chimeric free anterolateral thigh flap and muscle flap for heel ulcer reconstruction: A case series and technical refinements.

[BACKGROUND] The free anterolateral thigh flap has become a preferred option for skin defect reconstruction, particularly for heel ulcers. Due to the heel's weight-bearing role and potential bone destruction from ulcers, an anatomical-functional repair is essential for functionality restoration. This study reports long-term outcomes of a chimeric ALT fasciocutaneous flap combined with vastus lateralis muscle for calcaneal ulcer reconstruction, showing restored heel weight-bearing capacity.

[METHODS] We retrospectively analyzed nine consecutive cases of heel ulcers from June 2020 to June 2022. All patients presented with exposed calcanei, five of whom had calcaneal infections. The nine cases underwent reconstruction using free anterolateral thigh (ALT) fasciocutaneous flaps combined with vastus lateralis muscle. The appearance of the flap and the functional recovery of the feet were assessed using the Freiburg ankle scoring system at the final follow-up visit.

[RESULTS] The mean follow-up time was 12 months (range 6-18 months). The free flaps survival rate was 100 %. All patients had a successful return to ambulation. A linear scar remained in the donor site. The Freiburg score at the last follow-up was 73-95, with a mean of 88.5. According to the Freiburg scores, eight cases were good, and one case was moderate.

[CONCLUSION] After the long-term follow-up, the chimeric free anterolateral thigh flap and muscle flap may restore the weight-bearing function of the heel. It can make the patient back to work and daily activities, increasing the quality of life.