Stepladder V-Y advancement flap for repair of postero-plantar heel ulcers

Random fasciocutaneous flaps with bilateral adipofascial pedicles were elevated from the posterior heel and transferred distally to defects of the postero-plantar heel in 4 patients, using a stepped incision technique, in combination with the V-Y advancement principle. In all cases the flap was successfully transferred without any linear scar or scar contracture in the posterior heel. The absence of recurrence of ulcers during the postoperative follow-up between 1.5 and 4 years indicated the reliability and durability of the flaps. Application of this procedure permits rapid resurfacing and excellent recontouring of small to moderate-sized defects of the heel with minimal donor site morbidity.