Han Paul Y, Ezquerro Ruben
Department of Diabetes, Endocrinology and Metabolism, Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, CA.
J Am Podiatr Med Assoc. 2011 Mar-Apr;101(2):167-75. doi: 10.7547/1010167.
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.
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.
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.
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.
在疗养院中，患有不同程度下肢挛缩的卧床患者经常出现足跟部慢性不愈合压疮。对这些患者进行保守的局部伤口护理可能耗时、无效、成本高，而且可能只会推迟最终的大腿截肢。本研究评估了保肢手术（部分跟骨切除术、全跟骨切除术以及切除整个跟骨和距骨）治疗足跟溃疡的疗效。
我们对12年来治疗的57例患有足跟部慢性感染性不愈合压疮的疗养院居民进行了回顾性研究。43例患者接受了部分跟骨切除术，9例接受了全跟骨切除术，5例接受了切除整个跟骨和距骨的手术。术后平均随访时间为15个月。本研究还纳入了具有代表性的手术病例。
43例患者完成了随访。25例患者（58%）实现了完全愈合。18例患者（42%）因持续感染或复发导致足跟溃疡未愈，最终接受了膝下或膝上截肢。所有足跟压疮患者均被发现存在下肢挛缩。
对于患有足跟溃疡的非行走性挛缩患者，部分或全跟骨切除术或切除整个跟骨和距骨不仅为解决感染问题，也为预防肢体缺失提供了一种可行的选择。还必须制定积极的计划来解决下肢挛缩问题，以防止复发。
