# Usefulness of Lateral Arm Free Flap in Heel Reconstructions After Malignant Skin Tumor Excision: An Observational Study

## TL;DR

This study shows that using a lateral arm free flap for heel reconstruction after skin cancer removal leads to good functional and aesthetic results.

## Contribution

The study demonstrates the reliability of lateral arm free flaps for heel reconstruction, offering functional and aesthetic benefits.

## Key findings

- All eight patients had successful flap survival with satisfactory functional and aesthetic outcomes.
- Postoperative LEFS and AOFAS scores showed significant improvement compared to preoperative scores.
- Minor donor site complications occurred but resolved with conservative management.

## Abstract

Background/Objectives: Heel reconstruction is a complex procedure that requires soft tissue reconstruction resistant to weight, pressure, and shear stress. Various flap reconstruction methods have been reported; among them, free fasciocutaneous flaps have advantages in terms of function and aesthetics, but also have challenges due to the longer operation time required and the possibility of failure. The primary aim of this study was to examine the functional outcomes of heel reconstruction using free lateral arm fasciocutaneous flaps after wide excision of heel skin cancer. Methods: Between January 2014 and December 2020, eight patients underwent wide excision of skin cancer and reconstruction of the heel with a lateral arm free flap. Perioperative clinical data and postoperative outcomes, including flap survival, complications, Lower Extremity Functional Scale (LEFS) score, and American Orthopaedic Foot and Ankle Society scale (AOFAS) score, were analyzed from clinical records. Functional assessments were performed at a minimum of 12 months postoperatively (mean 18.3 months, range 12–24 months) by a single blinded examiner who was not involved in the surgical procedures. Both preoperative and postoperative LEFS and AOFAS scores were recorded for comparison. Results: The mean size of the skin and soft tissue defect was 32 cm2, the mean duration of surgery was 179 (range: 160–215) minutes, and the mean duration of hospital stay after surgery was 17 (range: 14–19) days, with a mean follow-up period of 48 (range: 33–59) months. Among the eight patients, two had diabetes mellitus (25%), one had peripheral neuropathy (12.5%), and none had clinically significant peripheral vasculopathy. All flaps survived, with one congestive episode. Satisfactory aesthetic and functional results were observed in all patients. The mean preoperative LEFS score was 28 (SD ± 6.1), which improved significantly to a postoperative mean of 57 (SD ± 8.3). Similarly, the mean preoperative AOFAS score was 45 (SD ± 5.8), improving to a postoperative mean of 61 (SD ± 6.2). Minor donor site complications included hypertrophic scarring in two patients (25%) and transient sensory changes in the lateral arm region in three patients (38%), all of which resolved with conservative management. Conclusions: This research suggests that the lateral arm free flap can be considered a reliable option in heel reconstruction, resulting in acceptable functional and aesthetic outcomes. It provides excellent durability, with solid bony union and good contour in small to moderate-sized heel defect cases.