Malignant melanoma of the skin is a highly aggressive malignant tumor. Surgical excision of the tumor is currently one of the most prominent comprehensive treatments for malignant melanoma. Since malignant melanoma is prone to local recurrence, the resection of the primary lesion should be extensive. The extent of excision includes both excision margin and excision depth. The heel is one of the good sites for melanoma. Since the heel is the main weight-bearing area of the body, the skin is thick and tough, wear-resistant and pressure-resistant. It also has a special tissue structure with dense longitudinal fibrous tissue connecting the heel bone, forming a thick soft tissue cushion that serves as a cushion for gravity, weight-bearing and walking. The incision is often difficult to close directly after resection of malignant melanoma in the heel area. Figure 1. Preoperative situation In recent years, local rotational flaps have been used to cover the defects in the heel region after resection of malignant melanoma, achieving ideal cosmetic and clinical results. There are two main types of flaps: the peroneal nerve retrograde flap and the medial plantar flap. Both flaps have their advantages and disadvantages: the medial plantar flap has a more constant vascular-medial plantar artery supply, a thick skin keratinization layer, and is resistant to friction; there is a dermal ligament within the flap, and the skin is less slippery and has a texture similar to that of the heel, so the appearance of the flap is similar to that of the heel. At the same time, the flap is innervated by the medial nerve branch of the plantar area and is located in a non-weight-bearing area, so the flap has little impact on the function of the foot after excision. It is currently the most ideal choice to close the wound after resection of tumor in the heel area. However, the proximal segment of the medial plantar artery needs to be severed during surgery, which may cause greater damage when the vessel is separated and exposed; moreover, the lateral side of the foot is a secondary weight-bearing zone, so the medial plantar flap cannot be too large, and the diameter is generally less than 8.0 cm, thus limiting its application to some extent. The gastrocnemius nerve retrograde flap, however, can be viable even in patients with poor blood flow conditions in the recipient area because of its constant nutrient vascular path, reliable arterial supply and adequate venous return; the flap is simple to cut and does not require anastomosis of the vessels; the donor area is hidden, with little damage, and does not destroy the function of the lower limb, and most of the wound can be directly sutured, which saves time and is convenient; the flap does not sacrifice the main artery, and the flap has good texture and moderate thickness. The flap does not sacrifice the main artery, and it has good texture and moderate thickness. It can repair defects in the heel with a diameter of 8 cm or more. However, the postoperative flap is bloated and has a poor appearance; moreover, the flap is not innervated by the main nerve and sensation is not easily restored, so activity should be limited in the early postoperative period and the wear and tear of the flap should be observed. Figure 2. Postoperative situation