A 23-year-old woman, resident in Celaya, Guanajuato (Mexico), with a history of direct trauma by a moving vehicle in the left lower extremity of 5 years of evolution was treated with internal fixation blus
At the time of visiting us, the patient presents residual bloody area and recurrent ulcerations in the heel region due to lack of protective sensitivity of the support zone.
Biopsies were taken from the edges and bloody area of the heel zone to rule out a malignant process; the diagnosis was pseudoepitheliomatous hyperplasia.
Antimicrobial treatment was administered according to bacteriological culture results and antibiogram for eradication of Staphylococcus aureus, with surgical debridement and debridement of hypertrophic granulation tissue of the ulcerated region negative until the result was obtained.
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Color Doppler ultrasound was performed to identify popliteal and tibial vessels with adequate perfusion, with no data of peripheral vascular compromise. A change in the skin coverage of the reverse flap was planned.
The flap was designed on the posterior third of the area underneath it 5 cm. below the poplite hollow, identifying the 11 axis of the neurovascular bundle with an incision of 1 cm. and then centering on the flap.
Neurovascular structures were connected and distally mounted on the border of the fasciocutaneous island.
We continued the incision in the inferior border of the zigzag flap and performed subfascial dissection of the flap at the level of the gastrocnemius muscles using a magnification with a subcutaneous vein of 3.5 cm wide the flap.
We placed a skin graft of partial thickness of 14 mm. of inch on the anterolateral surface of the left thigh over and above the donor site of the flap.
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The flap was cured with adequate evolution, with no data of venous congestion or arterial irrigation, so that 15 days later we started the intermittent ligation (mechanical delay) of the flap colored structures with the patient informed bandage type 4.
These delay periods to favor neovascularization increased tolerance on the part of the patient, so we gradually increased them from 5 minutes every 4 hours to 10 minutes every 6 hours and so for 20 hours.
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On the 22nd day, we placed the nerve in the midline to perform the section of the foot, extending 20 cm from the sural nerve, with end-to-end epineural coaptation made with 8-0 nylon of the proximal stump.
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The patient was discharged home without complications 30 days after surgery to continue outpatient follow-up.
It should be noted that the patient was treated in hospital due to the distance from her usual place of residence and attending to her own request.
