Orthoplastic management of open calcaneal fractures: A systematic review of flap selection and complications.
David Kwan Ryung Lee, Dave Osinachukwu Duru, Johannes Coetzee et al.
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In 30 seconds
This systematic review examined flap-based orthoplastic reconstruction in adults with open calcaneal fractures. Thirteen studies reporting 88 major flap reconstructions were included. Overall flap survival was 97.7%, with two failures, both involving muscle or myocutaneous flaps. Fasciocutaneous flaps had the lowest reported complication rate (8.3%) and no reported infections; muscle or myocutaneous flaps accounted for both failures and the only reported amputation. Heterogeneity and small study samples prevented meta-analysis, limiting comparisons between flap types.
Key findings
- Across 88 major flap reconstructions, overall flap survival was 97.7%, with two failures, both involving muscle or myocutaneous flaps.
- Fasciocutaneous flaps had an 8.3% complication rate and no reported infections.
- Muscle or myocutaneous flaps had reported infection in 20% of cases and accounted for both flap failures and the only reported amputation.
- Chimeric flaps (n=32) had reliable survival but vascular compromise in 6.3%; osteocutaneous flaps (n=4) had infection in 50% of cases.
Why it matters
Open calcaneal fractures combine major bone and soft-tissue injury, making durable coverage central to reconstruction. The review describes high overall flap survival and suggests that outcomes and potential roles differ by flap type and wound context. These findings can inform multidisciplinary discussion, while the limited and heterogeneous evidence means they do not establish comparative superiority.
What to keep in mind
Only 13 studies and 88 reconstructions were included; small samples and heterogeneity prevented meta-analysis, limiting reliable comparisons between flap types.