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The Partial Calcanectomy: A Limb Salvage Procedure That Is Not So Straightforward
BACKGROUND: Heel ulcers are often seen in fragile patients with various trials such as comorbidities, chronicity of the ulcer, anatomy and location, appropriate offloading, mechanical issues, and even social circumstances. Heel ulcers are one of the most difficult wounds to treat conservatively. Often, heel ulcers may become limb and even life threatening where surgical intervention such as a partial calcanectomy is warranted. The authors review cases of partial calcanectomies as limb salvage procedures with their respective treatment strategies and with their unique challenges that make this procedure not so straightforward.
OBJECTIVE: The authors describe the preoperative work-up, patient medical management, surgical approaches, and postoperative care of 3 patient with heel wounds.
METHODS: A retrospective chart review is performed on 3 cases involving patients with heel wounds. One case describes the challenges in a young 22-year-old paraplegic man, secondary to a gunshot wound, found to have osteomyelitis complicated by persistent bacterial contamination secondary to a chronic sacral wound ulcer. Another case describes a heel wound in a 70-year-old male veteran with dementia found to have gas gangrene and osteomyelitis complicated by social settings. The third case describes a heel wound in a 55-year-old man with diabetic neuropathy found to have associated septicemia with osteomyelitis complicated by multiple deep abscesses.
RESULTS: For each case, the authors describe preoperative evaluation and imaging. Appropriate medical management and stabilization were addressed. Partial calcanectomies were performed, and the authors describe the surgical approach and intraoperative findings. Microbiology and pathology results are discussed. The postoperative course and management are reviewed along with their respective complications and presented challenges.
CONCLUSIONS: Podiatric surgeons and multidisciplinary physicians should understand the clinical presentation, preventative strategies, appropriate conservative and surgical treatment, as well as postoperative management in patients with heel ulcers in which a partial calcanectomy is warranted as a limb salvage procedure. However, one should be aware that challenges are often met in at-risk patients that are not just medical or comorbidities but may be attributed to mechanical and physical circumstances, social environment, and even patient nonadherence.
CITATION
Fernandez J, Sanders EA, Saar BJ. The partial calcanectomy: a limb salvage procedure that is not so straightforward. Poster presented at: Symposium on Advanced Wound Care Fall; November 2-4, 2018; Las Vegas, NV.
Product: N/A
This abstract was not subject to the WOUNDS peer-review process.
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