Purpose: three dimensional (3-D) virtual planning is an example of computer assisted surgery that improved management of composite tissue defects. However, converting the 3-D construct into two dimensional format is challenging. The purpose of this study was to assess 3-D virtual planning of complex heel defects for better optimized reconstruction.Patients and methods: a prospective analysis of 10 patients [9 male and 1 female; mean age = 27.9 years] with post-traumatic heel defects was performed. Heel defects comprised types II (three patients) or III (seven patients) according to Hidalgo and Shaw and were managed using anterolateral thigh (ALT) free flap adopting 3-D virtual planning of the actual defect which was converted into a silicone two dimensional mold. The mean definitive size of the defects was 63.4 cm 3 . Functional, aesthetic, and sensory evaluations of both donor and recipient sites were performed 1 year after surgery.Results: Six patients received thinned ALT (mean size = 139 cm 3 ) while four patients received musculofasciocutaneous ALT flap (mean size = 199 cm 3 ). One flap exhibited partial skin flap necrosis. Another flap was salvaged after re-exploration secondary to venous congestion. The mean follow-up was 20.2 months. The Maryland foot score showed 4 excellent, 5 good, and 1 fair cases. The mean American Orthopedic Foot and Ankle hind foot scoring was 76.3 (range: 69-86). All patients regained their walking capability.Conclusions: 3-D virtual planning of complex heel defects facilitates covering nonelliptical defects while harvesting a conventional elliptical flap with providing satisfactory functional outcomes and near-normal contour, volume, and sensibility. | INTRODUCTIONHeel defects vary in severity ranging from simple skin defects to complex soft tissue and bony defects. Such defects may result from mechanical, chemical or thermal injuries in addition to tumoural resection, peripheral artery occlusive disease, diabetic neuropathy or prolonged bed recumbency (Struckmann et al., 2014). Hidalgo and Shaw have classified these injuries according to the degree of soft tissue and bony involvement into three types; type I (small soft tissue defects), type II (larger soft tissue defects without bony involvement),

The Rationale: Although 25%–45% of schwannomas are originating from the neck, carotid space schwannomas are extremely rare. Patient Concerns: We report a rare case of huge-sized schwannoma in a 20-year-old student who presented with a symptomless large carotid space mass. Diagnosis: Cervical magnetic resonance imaging (MRI) with contrast revealed a huge, well-defined mass measuring 13.7 cm × 6.4 cm × 4.1 cm. Cervical MRI along with brain MRI were consistent with neurofibromatosis type II. Treatment and Outcomes: Preoperative tracheostomy and wide local excision of schwannoma via a transcervical approach were performed with nerve preservation. Takeaway Lessons: The scarceness of cervical sympathetic chain schwannoma made this case of our patient very interesting to report. Moreover, our patient's huge tumour size is extremely rare, and we could not find any similar cases in the literature.