title: Surgical treatment of pressure ulcers of the heel in skilled nursing facilities: a 12-year retrospective study of 57 patients.
abstract: BACKGROUND
  Chronic nonhealing pressure ulcers of the heel in nursing homes are frequent occurrences among bedridden patients with lower-extremity contractures of varying degrees of severity. Conservative local wound care for these patients can be time consuming, ineffective, costly, and may only delay an eventual major leg amputation. This study evaluates the efficacy of limb salvage surgical procedures, partial calcanectomy, total calcanectomy, and excision of the entire calcaneus and talus, for heel ulcers.
  
  
  METHODS
  We performed a retrospective review of 57 nursing home residents who had chronic infected nonhealing pressure ulcers of the heel that we had treated over 12 years. Forty-three patients underwent partial calcanectomy, nine underwent total calcanectomy, and five underwent excision of the entire calcaneus and talus. Average postoperative follow-up was 15 months. Also included in this study are representative surgical cases.
  
  
  RESULTS
  Forty-three patients completed follow-up. Complete healing occurred in 25 patients (58%). Failure to resolve the heel ulcer owing to persistent infection, or recurrence was seen in 18 patients (42%) who eventually had a below-the-knee or above-the-knee amputation. All of the patients with heel pressure ulcers were found to have lower-extremity contractures.
  
  
  CONCLUSIONS
  In the nonambulatory contracted patient with a heel ulcer, partial or total calcanectomy or excision of the entire calcaneus and talus offer a viable alternative not only for resolution of infection but also for prevention of limb loss. An aggressive plan must also be instituted to address the lower-extremity contractures in order to prevent recurrence.
authors.affiliation: Department of Diabetes, Endocrinology and Metabolism, Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, CA. phan@coh.org
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Han
authors.forename: Ruben
authors.initials: R
authors.lastname: Ezquerro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006365:Heel / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D003668:Pressure Ulcer / Q000601:surgery*; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing