title: Healing of partial flap necrosis in ankle disarticulation amputation by débridement and continued weight-bearing.
abstract: Five patients with partial tissue loss of the weight-bearing surface of the heel pad following ankle disarticulation were treated with residual-limb debridement and continued end-weight-bearing using a total-contact cast. The patients, ranging in age from 53 to 76 years, had insulin-requiring diabetes and insensate heel pads and were low-demand, limited-activity, community walkers before amputation surgery. Each underwent amputation surgery as a consequence of peripheral vascular disease. All patients progressed to complete wound healing over 3 to 6 months and were able to return to their previous ambulatory level using a prosthesis. At a minimum 2-year follow-up, no patient experienced further residual-limb complications. Partial loss of the weight-bearing heel pad in ankle disarticulation amputation does not preclude successful return to independent ambulation using a standard ankle disarticulation prosthesis. Weight-bearing ambulation need not be avoided during healing.
authors.affiliation: Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Pinzur
authors.forename: A
authors.initials: A
authors.lastname: Patwardhan
authors.forename: R M
authors.initials: RM
authors.lastname: Havey
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000379:methods*; D000672:Amputation Stumps / Q000473:pathology* / Q000503:physiopathology; D000842:Ankle / Q000473:pathology / Q000601:surgery*; D003646:Debridement; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D016491:Peripheral Vascular Diseases / Q000209:etiology / Q000601:surgery; D013524:Surgical Flaps / Q000473:pathology; D016474:Weight-Bearing; D014945:Wound Healing