The Vertical Contour Calcanectomy, an Alternative Approach to Surgical Heel Ulcers: A Case Series

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...

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Bibliographic Details
Published in:The Journal of foot and ankle surgery 2019-11, Vol.58 (6), p.1067-1071
Main Authors: Cates, Nicole K., Wang, Kaihua, Stowers, Jered M., Attinger, Christopher E., Kim, Paul J., Steinberg, John S.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
below-the-knee amputation
calcaneal ulceration
Calcaneus - surgery
District of Columbia - epidemiology
Female
Follow-Up Studies
Foot Ulcer - surgery
functional outcomes
Heel - surgery
Humans
Incidence
Male
Middle Aged
Orthopedic Procedures - methods
Postoperative Complications - epidemiology
Retrospective Studies
Treatment Outcome
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Summary: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.
ISSN:1067-2516
1542-2224
DOI:10.1053/j.jfas.2019.04.010