ICOPLAST Award of Excellence: Elena Lucattelli

Italy / Societa Italiana di Chirurgia Plastica Ricostrutiva ed Estetica

Calcaneal Reconstruction After Total Calcanectomy with Free Iliac Crest Flap


Introduction: Calcaneal tumors being a rare occurrence, surgical options and outcomes are not well known. Total calcanectomy can be the treatment of choice in aggressive benign tumors and in selected cases of malignant tumors. Extensive defects following wide resection, especially in weight-bearing areas, still remain a challenge and different reconstructive techniques have been proposed.

Patients and methods: We conducted a retrospective review of 4 patients who underwent calcaneal reconstruction using an iliac crest free flap after total calcanectomy between 1999 and 2012. The following data were examined: histologic diagnosis, surgical details, adjuvant therapy, postoperative complications, time required for bone union, oncologic and functional outcome.

Results: The patients were evaluated at an average of 13 years (range 6-19) at latest examination.

Minor complications during the postoperative period healed with conservative treatment. All the arthrodesis healed successfully, as shown by radiographic findings. No donor site complication occurred. None of the patients claimed pain, evident limp or limitation of daily activities. A computerized pedobarographic examination and a gait analysis were performed, comparing the affected foot with the contralateral one.

Conclusions: In comparison to allograft or prosthetic replacement of the calcaneus, a vascularized bone graft is likely to provide more chances of a long-lasting result and less long-term complications. The iliac bone is a good choice because of low donor site morbidity and because of the possibility to adequately shape the graft to fit the bone loss while using the crest as the weightbearing surface.