title: A regional pedal ischemia scoring system for decision analysis in patients with heel ulceration.
abstract: OBJECTIVE
  The objective of this study was to evaluate patients undergoing operative debridement for heel ulceration and to categorize pedal perfusion and its influence on therapeutic alternatives.
  
  
  METHODS
  Patients with heel ulceration were stratified by arteriography and graded I (patent posterior tibial, PT), II (occluded PT/reconstituted from peroneal), III (PT reconstituted from dorsal pedal), IV (no PT reconstitution but visible heel tributaries), and V (avascular heel).
  
  
  RESULTS
  From May 1992 through January 1997, 23 patients underwent operative treatment for 25 heel ulcers. The heel ischemia score stratified patients into two groups: 1, revascularization/debridement (71% grades I to III, 29% grade IV, 0% grade V); and 2, free tissue transfer with or without revascularization (100% grades IV, V). Cumulative functional limb salvage was 91% (BP), 60% (BP + TT), and 81% (TT) at 24 months (P = 0.15 log rank).
  
  
  CONCLUSIONS
  The heel ischemia score may direct treatment of heel ulceration by identifying patients who will need vascularized tissue transfer early in their treatment regimen.
authors.affiliation: Section of Vascular Surgery, University of Arizona Health Sciences Center, Southern Arizona Vascular Institute, Tucson 85754-5727, USA.
authors.forename: A T
authors.initials: AT
authors.lastname: Gentile
authors.forename: S S
authors.initials: SS
authors.lastname: Berman
authors.forename: K R
authors.initials: KR
authors.lastname: Reinke
authors.forename: C P
authors.initials: CP
authors.lastname: Demas
authors.forename: D H
authors.initials: DH
authors.lastname: Ihnat
authors.forename: J D
authors.initials: JD
authors.lastname: Hughes
authors.forename: J L
authors.initials: JL
authors.lastname: Mills
mesh_terms: D000792:Angiography; D003646:Debridement; D017719:Diabetic Foot / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005528:Foot / Q000098:blood supply* / Q000000981:diagnostic imaging; D016523:Foot Ulcer / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006365:Heel / Q000098:blood supply; D006801:Humans; D007511:Ischemia / Q000175:diagnosis*; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps; D016896:Treatment Outcome