The lateral calcaneal artery skin flap (the lateral calcaneal artery, lesser saphenous vein, and sural nerve skin flap).

The lateral calcaneal artery skin flap is an axial-pattern flap that can provide skin flap coverage over the exposed calcaneal tendon or os calcis on the posterior or plantar heel. The flap can be designed as a short (8.0 X 4.5 cm in the adult) vertical flap or a long (14.0 X 4.5 cm) flap that curves forward to the base of the fifth metatarsal. Anatomic dissection and Doppler flow studies have been done on healthy volunteers and in patients with severe peripheral vascular disease. There was blood flow in the lateral calcaneal artery in 100 percent of the healthy patients and in 92 percent of those with peripheral vascular disease. Caution must be observed when planning the long version of the flap to be certain that there is adequate arterial flow. We recommend directional Doppler studies in all patients in whom the long version of the flap is planned. When there has been significant lower extremity trauma, an angiogram should be obtained before proceeding with either the short or long version of the flap. When the long lateral calcaneal artery flap is to be used, parallel sides of the flap should be incised and undermined and a vascular clamp should be placed on the distal end of the flap. The intravenous fluorescein test is then performed before determining whether to divide the third side of the flap or to delay it.