TY - JOUR
T1 - The Vertical Contour Calcanectomy, an Alternative Approach to Surgical Heel Ulcers
T2 - A Case Series
AU - Cates, Nicole K.
AU - Wang, Kaihua
AU - Stowers, Jered M.
AU - Attinger, Christopher E.
AU - Kim, Paul J.
AU - Steinberg, John S.
N1 - Funding Information:
Financial Disclosure: This study was supported by the Department of Plastic Surgery, MedStar Georgetown University Hospital.
Publisher Copyright:
© 2019 the American College of Foot and Ankle Surgeons
PY - 2019/11
Y1 - 2019/11
N2 - Heel ulcers have a significant impact on lower-extremity morbidity and confer high risk of major amputations. Treating these ulcers is difficult because of poor tissue coverage and the bony os calcis, often leading to proximal amputation. This case series shows the vertical contour calcanectomy (VCC) as a surgical alternative in functional limb salvage. Sixteen feet (14 patients) with recalcitrant heel wounds who underwent VCC were identified. The minimum follow-up time for inclusion was 1 year. Body mass index, diabetes, renal disease, peripheral vascular disease, lymphedema/venous insufficiency, smoking status, Charcot, amputation, vascular intervention, wound recurrence, reoperation rate, and ambulatory status were evaluated. The average follow-up time was 27.1 months (range 13.5 to 51.1). At 1 year of follow-up, 56% of heel wounds (9 of 16) treated with the VCC remained closed. An average of 1.44 subsequent surgeries were required per patient. Baseline or improved ambulatory status was achieved in 69% of patients (9 of 14) at 1-year follow up and 100% of patients (8 of 8) at 2-year follow up. The overall rate of major amputation was 19%. The long-term ambulatory status of patients treated with the VCC shows promise. The VCC should be considered as an alternative, reliable, surgical limb salvage tool for heel ulcerations.
AB - Heel ulcers have a significant impact on lower-extremity morbidity and confer high risk of major amputations. Treating these ulcers is difficult because of poor tissue coverage and the bony os calcis, often leading to proximal amputation. This case series shows the vertical contour calcanectomy (VCC) as a surgical alternative in functional limb salvage. Sixteen feet (14 patients) with recalcitrant heel wounds who underwent VCC were identified. The minimum follow-up time for inclusion was 1 year. Body mass index, diabetes, renal disease, peripheral vascular disease, lymphedema/venous insufficiency, smoking status, Charcot, amputation, vascular intervention, wound recurrence, reoperation rate, and ambulatory status were evaluated. The average follow-up time was 27.1 months (range 13.5 to 51.1). At 1 year of follow-up, 56% of heel wounds (9 of 16) treated with the VCC remained closed. An average of 1.44 subsequent surgeries were required per patient. Baseline or improved ambulatory status was achieved in 69% of patients (9 of 14) at 1-year follow up and 100% of patients (8 of 8) at 2-year follow up. The overall rate of major amputation was 19%. The long-term ambulatory status of patients treated with the VCC shows promise. The VCC should be considered as an alternative, reliable, surgical limb salvage tool for heel ulcerations.
KW - 4
KW - below-the-knee amputation
KW - calcaneal ulceration
KW - functional outcomes
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U2 - 10.1053/j.jfas.2019.04.010
DO - 10.1053/j.jfas.2019.04.010
M3 - Article
C2 - 31679660
AN - SCOPUS:85074157305
SN - 1067-2516
VL - 58
SP - 1067
EP - 1071
JO - Journal of Foot and Ankle Surgery
JF - Journal of Foot and Ankle Surgery
IS - 6
ER -