PMC3284307_01
(A) Preoperative picture of the left calcaneal osteomyelitis with the large wound at initial presentation. (B) Preoperative angiography showing the popliteal artery occlusion.
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The patient had a history of smoking for many years and also sustained a calcaneal osteomyelitis secondarily to the original infection with Staphylococcus aureus and Pseudomonas aeruginosa organisms (Fig. 1A). In our facility, the patient had immediate non-invasive vascular studies that were followed with a lower extremity angiography that showed a vascular occlusion of the popliteal artery around the popliteal fossa (Fig. 1B).
(A) Intraoperative picture showing harvesting of the large sural pedicle flap to cover the calcaneal resected osteomyelitis with a severe soft tissue loss. (B) Immediate postoperative picture showing the insetting of the sural flap at the recipient area with minimal skin tension.
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The sural flap was then rotated to the defect area and was secured without any skin tension (Fig. 2).
Postoperative outcome at 4-month follow-up.
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The flap was completely healed and the patient was ambulatory with a custom molded shoe at 4 months postoperatively (Figs. 3 and 4).
Final postoperative outcome and range of motion of the ankle at 7-month follow-up.
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The flap was completely healed and the patient was ambulatory with a custom molded shoe at 4 months postoperatively (Figs. 3 and 4).