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The lateral calcaneal artery fasciocutaneous transpositional flap is utilized for coverage in a case presentation of a 6-year-old child with an insensate posterior heel defect. The procedural technique and 32-month follow-up is described. Advocacy of this flap, for this patient, and potential detriments of alternative coverage options are discussed.

Long-term patient satisfaction and objective clinical and radiographic examinations of patients who had undergone the Z-bunionectomy at the University of Chicago Medical Center were evaluated. Fifty-six surgeries were performed on 31 patients, with a follow-up range of 5 to 9 years. The University of Maryland 100-Point Painful Foot Center Scoring System was modified to be more specific to bunion surgery, and we used this modification to measure patient satisfaction. Patient satisfaction was rated good to excellent by 90% of the patients. Radiographic findings included: intermetatarsal angle-mean, 7.1 degrees; hallux abductus angle-mean, 8.96 degrees; tibial sesamoid position-mean, 2.8. The mean protrusion was -1.64 mm. Radiographic findings consistent with osteonecrosis were noted of one patient, one foot, although the patient was clinically asymptomatic. The objective findings were as follows: dorsiflexion, mean, 60 degrees; plantarflexion, mean, 14 degrees. No patients had pain or crepitus, nor were they tract-bound in their first metatarsophalangeal joint range of motion. In addition, stance dorsiflexion had a mean of 21 degrees, and the purchase power was 88% good to excellent on plantar paper pull-out testing. First ray motion qualitatively demonstrated 1 1/2 to 2 times dorsiflexion to plantarflexion. There were no subsecond metatarsal head keratoses. Generalized ligamentous laxity was not seen. For the resting calcaneal stance position the mean was 3.5 degrees everted, with 24% of the patients maximally pronated in this position. We were unable to correlate any structural and functional postoperative features with patient satisfaction.

The source and depth relationships of both isolated burns to the feet and pedal burns as part of multifocal thermal trauma are evaluated. Five years of cases at the University of Chicago Burn Center were selected at random and retrospectively reviewed. There were 33 isolated burns of the foot, with a source distribution of 70% scald, 9% grease, 9% hot solid, 6% flame, and 6% other. In patients with multifocal burns that included that foot, there were 89 cases, with a source distribution of 42% scald burns, 5% grease, 2% hot solid, 39% flame, 5% electrical, 1% frostbite, and 6% other. Source versus depth and grafting needs are presented. Admission to hospital which was delayed from the date of burn showed an increased need for grafting and a longer hospitalization than those admitted on the same day. Immediate admission for compliance of proper treatment protocol is advocated. Isolated pedal burns were most commonly sustained at home, indoors, and in the kitchen. A significant number of isolated burns to the feet were from a scald source, partial thickness in depth, and required no grafting. Much of the wound management involved treating elements found in traumatic, dysvascular, and diabetic pedal lesions.