Large and Deep Diabetic Heel Ulcers Need not Lead to Amputation

Foot and Ankle International - Tập 34 Số 2 - Trang 215-221 - 2013
Abolfazl Shojaiefard1,2, Zhamak Khorgami1,2, Mohammad Reza Mohajeri‐Tehrani3, Bagher Larijani3
1Research Center for Improvement of Surgical Procedures and Outcomes, Tehran University of Medical Sciences, Tehran, Iran
2Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
3Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences, Tehran, Iran

Tóm tắt

Background: Management of large and deep heel ulcers (LDHUs) is a challenge in patients with diabetic foot lesions. We assessed outcomes of a treatment protocol to save feet with LDHUs from amputation. Methods: We managed LDHUs (larger than 3 cm2) in diabetic feet using a multidisciplinary approach consisting of medical and surgical management, including revascularization and amputation, if necessary. For deep heel infection and/or gangrene, we frequently debrided and drained the deep spaces of the heel, as needed. In patients with non-ischemic feet, we made a flap from the heel pad with a broad pedicle. When satisfactory granulation tissue covered the base of the heel and the inner surface of the flap, we sutured the heel flap to its base. Results: We managed 37 feet with LDHUs among 384 patients. Twenty-nine patients (78.4%) had neuropathy, 6 (16.2%) had ischemic diabetic feet, and 2 (5.4%) had both neuropathy and ischemia. Twelve (32.4%) had septic diabetic feet. We performed two femoropopliteal bypasses, 2 infrapopliteal bypasses, and 1 distal bypass (crural) for ischemic heel ulcers. Thirty-three of the 37 feet with heel lesions (89.2%) were salvaged using this multidisciplinary approach. These 33 LDHUs healed after 4 to 7 months (median, 6 months). Transtibial amputation was performed for 4 feet (10.8%; 2 ischemic and 2 neuropathic cases). Conclusions: Diabetic patients with LDHUs can be managed with a multidisciplinary approach to prevent amputation. If necessary, deep spaces of the heel can be debrided by elevating the heel pad like a flap and then performing satisfactory reconstruction. Level of Evidence: Level IV, retrospective case series.

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Thông tin xuất bản

Foot and Ankle International

Tập 34 Số 2

215-221

Thông tin tác giả