I almost lost the bottom of my foot in a wreck but they was able to stitch it back on. 2 years ago ortho did debridement and cut off most of my heel. Local PS did a skin graft but it still tears to this day which he said is because it's normal skin and they can't put the tough skin from your foot back on. Is there anyway to maybe use a donor heel? Does anyone have a suggestion
If there is some heel it maybe able to expand the skin you have to extend it to the area of loss. Partial donation from your other foot as a a cross foot flap could solve the issue as well. Get special shoes is another answer to off load pressure on the thin skin. Orthotic shoes. Good luck.
A free flap may be possible. This is a difficult area to reconstruct.
Both good suggestions above. Tissue expansion on feet, especially the heel is problematic and has a high failure rate. There is much missing from your history. Is there good soft tissue padding on your heel? Without this, most grafts will do poorly. Was the skin graft a very thin one? If so, you might see about having it replaced with a full thickness skin graft. Thin grafts are fragile in weight-bearing areas whereas full thickness grafts are more robust. I have had success with this in weight-bearing areas. I use a wound VAC to help the graft heal (not heel) more reliably. If the graft is breaking down in the same, small area, orthotics to relieve the pressure, as suggested by Dr. Weinstein may do the trick. I would keep it simple and reserve something as complex as a microvascular free flap to a last resort. It is a very tough area to reconstruct! I wish you success.
Repeated fat grafting and skin graft might help.