{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T09:48:46Z","timestamp":1782294526748,"version":"3.54.5"},"reference-count":23,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Reconstruction of full-thickness soft-tissue defects of the heel can be challenging due to the specific structural and functional demands of this region. Local flaps are often used due to their ability to provide durable and sensate coverage. This case series and systematic review aim to assess their surgical efficacy and reported outcomes, particularly in the context of the rhomboid flap. Methods: A systematic review was conducted in accordance with PRISMA guidelines, using PubMed, Cochrane and EBSCO. Studies published up to March 2026 evaluating local flaps were included, whereas distant pedicled and microvascular flaps were excluded. Defect size, flap types and surgical outcome were extracted and synthesized in a comparative table. In addition, we present four clinical cases of full-thickness soft-tissue heel defects reconstructed with a local rhomboid flap. This retrospective, single-center case series includes patients treated at our institution between January 2023 and March 2026, with initial debridement followed by flap coverage. Results: The four patients had a mean defect size of 4.1 cm2. All defects ultimately healed, though one case demonstrated delayed wound healing. Eventually, neither donor-site morbidity, nor recurrence were observed during a mean follow-up of 7.4 months (range 1 to 17 months). Nine studies were included in the review, encompassing 56 patients. Despite the variety of the studies regarding design and flaps used, all focused on outcomes, including flap survival, complication rate, and functional recovery. Local flaps appear to be a feasible option for this type of soft-tissue defect; however, they seem to be limited to small defects. Conclusions: Local flaps may represent a valuable option for small full-thickness heel defects up to 6 cm2 according to the \u201clike-with-like\u201d principle. They are associated with low surgical morbidity and do not compromise subsequent reconstructive options, making them a reasonable first-line approach. Limitations include the small sample size, retrospective design, the unequal follow-up time, as well as the absence of standardized functional outcome assessment.<\/jats:p>","DOI":"10.3390\/jcm15134899","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T07:57:24Z","timestamp":1782287844000},"page":"4899","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Why Make Things Complicated When They Can Be Simple? Case Series and Systematic Review on the Reconstruction of Full-Thickness Soft-Tissue Heel Defects"],"prefix":"10.3390","volume":"15","author":[{"given":"Aur\u00e9lie","family":"Cavin","sequence":"first","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2236-4752","authenticated-orcid":false,"given":"Julie","family":"Triolo","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2557-249X","authenticated-orcid":false,"given":"Yves","family":"Harder","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland"},{"name":"Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00e9my","family":"Br\u00fchlmann","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/00000637-198111000-00007","article-title":"Surgical management of heel ulcers: A comprehensive approach","volume":"7","author":"Scheflan","year":"1981","journal-title":"Ann. Plast. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/S1083-7515(02)00010-4","article-title":"D\u00e9bridement: The key initial first step in wound healing","volume":"6","author":"Attinger","year":"2001","journal-title":"Foot Ankle Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5152\/eajm.2011.01","article-title":"Versatile use of rhomboid flaps for closure of skin defects","volume":"43","author":"Aydin","year":"2011","journal-title":"Eurasian J. Med."},{"key":"ref_4","first-page":"16","article-title":"Review of rhomboid flaps and their modern modifications","volume":"34","author":"Grammenos","year":"2016","journal-title":"J. Am. Osteopath. Coll. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Goldman, A., and Wollina, U. (2026). The Limberg rhomboid flap: History, creator, and importance in plastic surgery. Clin. Dermatol., in press.","DOI":"10.1016\/j.clindermatol.2026.01.013"},{"key":"ref_6","first-page":"e85546","article-title":"Limberg\u2019s Rhombic Flap: A Review of Embryological, Anatomical, and Clinical Considerations","volume":"17","author":"Lamprou","year":"2025","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"103328","DOI":"10.1016\/j.amsu.2022.103328","article-title":"Assessment of rhomboid flap scars: A patient reported outcome study. A case series","volume":"75","author":"Kang","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_8","unstructured":"MacNeal, P., Hohman, M.H., and Adlard, R.E. (2026, March 22). Rhombic Flaps. StatPearls 2026, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK558931\/."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.bjps.2022.11.009","article-title":"A modified perforator-based stepladder V-Y advancement flap in the Achilles tendon area for coverage of larger posterior heel defects","volume":"77","author":"Huang","year":"2023","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1055\/s-2006-942263","article-title":"Algorithmus zur Rekonstruktion von Weichteildefekten am distalen Unterschenkel, Sprunggelenk und R\u00fcckfu\u00df","volume":"144","author":"Eisenschenk","year":"2006","journal-title":"Z. Orthop. Ihre Grenzgeb."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"63","DOI":"10.52547\/wjps.10.3.63","article-title":"Reconstruction of heel soft tissue defects: An algorithm based on our experience","volume":"10","author":"Krishna","year":"2021","journal-title":"World J. Plast. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1053\/j.jfas.2007.12.010","article-title":"Soft tissue defects of the heel: A surgical reconstruction algorithm based on a retrospective cohort study","volume":"47","author":"Yassin","year":"2008","journal-title":"J. Foot Ankle Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1007\/s001040050052","article-title":"Therapeutische Optionen zur Behandlung von Fersendefekten","volume":"71","author":"Menke","year":"2000","journal-title":"Chirurg"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1007\/s001130170006","article-title":"Therapiestrategien zur Deckung traumatischer Defekte der Fersenregion","volume":"104","author":"Menke","year":"2001","journal-title":"Unfallchirurg"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1177\/107110070302400906","article-title":"Bilobed flaps for nonhealing ulcer treatment","volume":"24","author":"Yetkin","year":"2003","journal-title":"Foot Ankle Int."},{"key":"ref_16","first-page":"16","article-title":"Heel defect reconstruction using local vascularized flaps: Results and clinical outcomes in 16 patients","volume":"5","author":"Singh","year":"2018","journal-title":"J. Foot Ankle Surg."},{"key":"ref_17","first-page":"337","article-title":"Local plantar rotatory flap for repairing of soft tissue defect of heel","volume":"13","author":"Ding","year":"1999","journal-title":"Chin. J. Reparative Reconstr. Surg."},{"key":"ref_18","first-page":"100080","article-title":"Revised Preferred Reporting of Case Series in Surgery (PROCESS) guideline: An update for the age of artificial intelligence","volume":"10","author":"Agha","year":"2025","journal-title":"Prem. J. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1097\/00006534-197411000-00010","article-title":"The pathophysiology of skin flap circulation: The delay phenomenon","volume":"54","author":"Reinisch","year":"1974","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e107","DOI":"10.1097\/PRS.0000000000005448","article-title":"Strategies for reconstruction of the plantar surface of the foot: A systematic review of the literature","volume":"143","author":"Crowe","year":"2019","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_21","first-page":"e81484","article-title":"Dufourmentel rhomboid flap for plantar Charcot midfoot ulcer: A novel reconstructive approach","volume":"17","author":"Elhaddad","year":"2025","journal-title":"Cureus"},{"key":"ref_22","unstructured":"Mathes, S.J., and Nahai, F. (2010). Clinical Applications for Muscle and Musculocutaneous Flaps, C.V. Mosby Company. [2nd ed.]."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1097\/00006534-199406000-00027","article-title":"From the reconstructive ladder to the reconstructive elevator","volume":"93","author":"Gottlieb","year":"1994","journal-title":"Plast. Reconstr. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/4899\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T09:24:01Z","timestamp":1782293041000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/4899"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":23,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15134899"],"URL":"https:\/\/doi.org\/10.3390\/jcm15134899","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]}}}