Excellent outcome of healing by secondary intention after wide local excision of the weight-bearing heel

• Published in: JPRAS open 2022-06, Vol.32, p.178-181
• Main Authors: Gjorup, Caroline Asirvatham, Andersen, Peter Stemann
• Format: Article
• Language: English
• Subjects: Case Report; Conservative treatment; Heel; Melanoma; Negative pressure wound therapy; Weight-bearing; Wide local excision
• ISSN: 2352-5878; 2352-5878
• DOI: 10.1016/j.jpra.2022.02.009

Plantar defects are difficult to manage due to several reasons. The challenges of plantar reconstructions include lack of abundant local tissue, the requirement of the skin to be sensate, as well as the mechanical demand of the reconstruction to be able to withstand shearing forces and weight-bearing. Although rare, these defects are encountered following infections, trauma, and burns in addition to surgical oncological resections. This case report describes the management of a plantar defect, measuring 45 × 55 mm, after surgical resection of a melanoma on the weight-bearing heel. The defect was managed with negative pressure wound therapy (NPWT) for 4 weeks, until granulation tissue was flush with the surrounding skin. Conservative treatment with wound care was conducted for another 12 weeks, until the wound, at 16 weeks, was completely healed. The patient tolerated the lengthy time of healing well and experienced no problems with the scar, and the functional and aesthetic outcome of conservative treatment of the plantar defect was excellent. Healing by secondary intention is an excellent treatment option for the closure of large plantar defects, despite often being an overlooked reconstructive option.