Sural Nerve Neurocutaneous Cross-Foot Flap

Managing heel ulcers has proved frustrating because of the tendency for recurrence despite satisfactory use of grafts and flaps. This predisposition for continual breakdown is invariably associated with the loss of sensation. A neurocutaneous cross-foot flap was used to provide coverage and sensation to a heel after a degloving injury. Initially a full-thickness skin graft was used but resulted in a chronic, infected ulcer. Local tissue was not available for coverage. The neurocutaneous flap was based over the distribution of the sural nerve of the opposite foot. After proper delay, the flap was transferred. When the pedicle was divided, the sural nerve was anastomosed to the sural nerve in the recipient leg. This procedure has provided adequate padding and good sensation to the heel, preventing recurrence in this very active patient.