Reconstruction of a Plantar Heel Fat Pad Loss Utilizing a Piscine Graft After Chronic Ulceration and Calcaneal Osteomyelitis
Background: A 71 year old male with a past medical history significant for chronic kidney disease, thyroid disease, anemia, and venous stasis presented with bilateral heel wounds for 6 months. He had been treated in a wound care center with a wound vac and unna boots without success. His left heel ulcer probed deep to periosteum. Plain film radiographs showed lucency in the area. MRI showed decreased signal intensity on T1 and increased signal intensity on T2 suggestive of osteomyelitis.
Methods: The patient was taken for a partial calcanectomy with antibiotic bead placement. Three days later, a flap closure was utilized to close the wound and an external fixator was applied to keep pressure off of the flap. A piscine graft was inserted into the subcutaneous tissue.
Results: We have noticed that patients with heel fat pad loss often continued to have recurrent skin breakdown and ulceration in the heel due to inadequate soft tissue padding at the heel. By soft tissue augmentation with a piscine graft, the patient was able to heel without recurrent ulceration.
