Reconstruction of the weight-bearing heel area still represents a difficult problem for the plastic surgeon. A new technique for weight-bearing heel reconstruction with chimeric flap with stable and sensate skin is presented.
            Six patients with full thickness defects of the heel area were seen: in five, the defects were created by oncological resection of acral melanomas with immediate reconstruction and in one the defect was traumatic and reconstruction was secondary. The chimeric flaps were dissected from the lateral circumflex femoral system and were composed by a muscular cuff of the vastus lateralis muscle and a perforator based innervated skin island. The skin island was thinned through microdissection preserving vascular and neural structures. The muscular cuff was used for contour restoration. The thinned cutaneous tissue was adjusted over the muscle. After the flap was positioned, microvascular anastomoses to the posterior tibial vessels were done and neurorraphy of the sensitive nerve of the flap with the calcaneous branch of the posterior tibial nerve was performed.
            All flaps healed uneventfully. After one year postoperatively no ulcerations were observed.  In five patients there was recovery of protective sensation. The two point discrimination test on the flap area showed a mean value of 12 mm.
            The proposed technique is a combination of traditional methods used for heel reconstruction. In comparison with other cases operated in our clinic, it seems that this method can offer a potential for a more stable reconstruction of the weight-bearing area with the advantage of also being a sensate flap. Thinning of the flap may have contributed for better stability of the flap, avoiding the shearing forces often seen in conventional miocutaneous flaps.