A Suture Retention Device* used to Primarily Close Challenging Stage IV Heel Wounds – Case Series

Introduction: Heel wounds are among the most challenging due to their distal location, inelasticity of local tissue, the tendency of suture to tear plantar skin, and often high comorbidity of the patient due to neuropathy, vasculopathy, poor mobility, or all of the above. Local flap options are few and unreliable, and the high comorbidity of these patients often preclude rotational or free flaps for coverage.

Often these patients require a below-knee amputation to resolve this problem, as second intent healing may take many months and may not be successful. When possible, it is preferred to cover these wounds with local heel soft tissue, as it is uniquely suited for weight-bearing and shear forces.

Methods: Seven patients with Stage IV heel wounds are included in this series. All patients had either osteonecrosis or osteomyelitis and all underwent thorough debridement of the devitalized or infected bone. Once the wounds had stable viable tissue throughout with control of bioburden, advancement of local soft tissue was done with no undermining. Primary closure with heavy gauge monofilament full-thickness suture was done, including an adhesive suture retention device (ASRD)* on skin entrance and exit. The ASRD was left in place three to six weeks post-procedure until healing was deemed satisfactory.

Results: All seven patients were successfully closed without healing complications. The ASRD was removed uneventfully and was well tolerated.

Discussion/Conclusion: Conventional sutures placed in heel skin often tear the skin, especially in the presence of drainage and maceration. Successful surgical wound closure requires that the sutures hold the wound tissues in opposition long enough to allow the two sides to heal together. However, conventional sutures placed in heel skin often tear through the skin within days, especially in the presence of drainage and maceration. The use of the ASRD solves this problem, providing sustained mechanical support of the opposed tissues for enough time to achieve primary healing.