Management of 34 chronic heel sinuses in leprosy, using a modification of a local rotation flap in Kolkata, India

We have seen 55 trophic ulcers of the heel in 2 years in our hospital, between March 2000 and February 2002. Thirty-four were chronic heel sinuses, six cases of multiple sinuses and 28 cases of single sinus of the plantar aspect of the heel. All these cases were treated by excision of the sinus, paring the prominence of the calcaneum, or excision of the cavity within the calcaneum and coverage by a rotation flap or a modification of this flap. Over the past 6 years, we have evolved a modification of a rotation flap that requires a fusiform incision to excise the sinus, and a curved incision for the flap extending through the instep and the non-weight bearing heel. The fusiform excision, rather than the traditional triangulation, causes the flap to partly transpose rather than rotate completely. The flap is raised superficial to the plantar aponeurosis, exposing the aponeurosis from mid-sole to the heel. It is a modification of a rotation flap. The scarring over the weight-bearing sole is minimal, restricted only to the incision necessary for the excision of the heel sinus and this is its main advantage. Twenty-one of the 34 cases healed without complications. Thirteen cases had complications, of which six were treated non-operatively and seven required either a redo of the flap or another flap cover.