Clinical application of posterior calf fascio-cutaneous pedicle flap in leprosy foot ulcer.

Lower extremities of the leprosy patients are characterized by the decreased sensation of the foot from peripheral nerve damage. As a result, repetitive foot ulcers are frequently seen. When these repetitive shallow ulcers become infected, they result in deep soft tissue ulcers and even osteomyelitis. The treatment of these ulcers in leprosy is a challenging problem both to the patient himself and to medical personnel. Conventional treatment methods for these ulcers include, according to the wound condition, skin graft, local flap, long-term cast immobilization, wedge resection of the joint and even amputation in severe cases. But all these methods have the disadvantages of frequent recurrences, long hospitalization periods and permanent foot deformities. Recently in Korea, despite the decreased occurrences of new patients and the decreased frequencies of facial and hand deformity formation due to the active early diagnosis and treatment, there still exists a large number of foot deformities resulting from decreased foot sensation. Moreover, treatment modalities are not definitely established. In fact, there are many environmental difficulties in applying the free flap transfer to the foot ulcer of leprosy patients in leprosy sanatorium as opposed to treating the non-leprosy patients. And so, from 1990 to 1993, we performed 6 superior-based posterior calf cross leg flap transfers and 1 distal-based flap transfer, under spinal anesthesia, referred by the leprosy sanatorium for deep foot ulcers. We obtained favorable results in 6 patients and partial necrosis in a patient who received distal based flap transfer.

Chronic plantar ulcer of a leprosy patient treated by fasciocutaneous instep flap transfer. Preliminary result.

A case of chronic ulceration of the foot (chronicity about 15 years) was treated with fasciocutaneous instep flap transfer. The ulcer was on the heel. Healing was fast (about 40 days post-operatively. Duration for conventional method is about 6 months) and after 12 months of ambulation no recurrence was noticed. The female patient with only one lower limb (the other already amputated) now goes about smilingly selling her wares. However, the footwear for the patient had to be further modified.

Heel ulcer in leprosy treated with fasciocutaneous island flap from the instep of the sole.

Twenty-four leprous patients with longstanding ulcer of the weight bearing area of the heel underwent reconstruction by use of fasciocutaneous island flap from the instep. One flap was lost because the vascular pedicle was accidentally severed during the dissection. Infection delayed healing in three cases, and one patient developed minor necrosis of the edge of the flap without any adverse consequences. The remaining 18 cases healed without complications. Follow-up of 14 patients 3 to 10 months after the operation showed excellent results in all but the one whose flap was lost. The operation is recommended for difficult reconstructions of the heel.