title: A Novel and Alternative Treatment Method for Diabetic Heel Ulceration Exposing the Calcaneus Which Is Not Suitable for Flap Surgery: Vacuum Assisted Sandwich Dermal Matrix.
abstract: BACKGROUND
  Currently, free flaps and pedicled flaps are the first treatment choices for large heel ulcer reconstruction. However, flap reconstruction of heel ulcerations cannot be performed in all diabetics especially with concurrent severe peripheral vascular disease because of higher flap failure rate. In recent years, the use of acellular dermal matrix (ADM) has emerged as an alternative treatment option for extremity ulcers.
  
  
  METHODS
  We present 13 diabetic patients with a large heel ulceration exposing the calcaneus, who were not eligible for flap surgery due to the presence of only one patent artery of trifurcation. These cases were treated with the vacuum assisted sandwich dermal matrix (VASDEM) method.
  
  
  RESULTS
  None of the patients required amputation. Skin grafting was successful in ten patients. Although partial losses were observed in three patients, they were healed spontaneously without surgical interventions. During the follow-up period none of the patients developed ulceration on the treatment area. All patients maintained their preoperative ambulatory ability.
  
  
  CONCLUSIONS
  VASDEM is a novel method offering opportunity for treatment before proceeding to amputation in diabetic heel ulceration exposing the calcaneus which is not suitable for flap surgery. It also has the potential to close wounds of all sizes independent of the vessel status and wound size in selected diabetic patients.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Yeditepe Medical School, Yeditepe University, Devlet Yolu Ankara Caddesi No. 102-104, Kozyatağı, 34752 Istanbul, Turkey.
authors.forename: Ugur A
authors.initials: UA
authors.lastname: Bingol
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Yeditepe Medical School, Yeditepe University, Devlet Yolu Ankara Caddesi No. 102-104, Kozyatağı, 34752 Istanbul, Turkey.
authors.forename: Can
authors.initials: C
authors.lastname: Cinar
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University Cerrahpasa Faculty of Medicine, 34098 Istanbul, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Arslan
authors.affiliation: Private Office, 34365 Istanbul, Turkey.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Altındas
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D002111:Calcaneus / Q000503:physiopathology; D017719:Diabetic Foot / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006365:Heel / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016038:Skin Transplantation / Q000379:methods*; D012883:Skin Ulcer / Q000503:physiopathology / Q000601:surgery*; D013524:Surgical Flaps; D014618:Vacuum