A Case of Heel Reconstruction with a Reverse Sural Artery Flap in a Hemophilia B Patient

Hemophilia B is a rare blood coagulation disorder. Complications such as bleeding andhematoma can cause necrosis of flaps, wound disruption, and the disturbance of woundhealing. In particular, guidelines for flap operations in hemophilia B patients have still notbeen defined, and case reports are rare. We reconstructed the heel of a 41-year-old malehemophilia B patient using a reverse sural artery flap operation. The patient presented withmild hemophilia, having 27% of the normal value of coagulation factor IX. Coagulationand the changing value of the coagulation factor were regularly measured, and 70% of thenormal value of coagulation factor IX was maintained through the injection of recombinantcoagulation factors and antihemorrhagics. Hematoma developed twice (postoperative day[POD] 5 and POD 7) and in each case the hematoma was removed. Injections of recombinantcoagulation factors and antihemorrhagics were continuously administered until postoperativeweek 2. When the coagulation factors were within normal ranges. In this article, a hemophiliaB patient underwent reverse sural artery flap surgery and the healing progress was analyzed.We conclude that higher than baseline levels of coagulation factors are needed for successfulhealing in reverse sural artery flap surgery.