Abstract
The objective of this study is to evaluate peripheral perfusion in patients who developed
plantar heel ulcerations status after transmetatarsal amputation and Achilles tendon
lengthening. Peripheral perfusion was assessed via contrast angiography of the 3 crural
vessels (anterior tibial, posterior tibial, and peroneal arteries), as well as intact
heel blush and plantar arch. The secondary objective is to correlate the arterial
flow to time to develop heel ulceration and incidence of minor and major lower-extremity
amputation. Diagnostic angiography without intervention was performed on 40% of patients
(4/10), and interventional angiography was performed on 60% of patients (6/10). In-line
flow was present in 0% (0/10) of the peroneal arteries, 60% (6/10) of the anterior
tibial arteries, and 70% (7/10) of the posterior tibial arteries. Heel angiographic
contrast blush was present in 60% (6/10), and intact plantar arch was present in 60%
(6/10). Patients developed heel ulcerations at a mean time of 7.6 months (range 0.7
to 41.2) postoperatively. The incidence of major lower-extremity amputation was 30%
(3/10), with a mean time of 5.2 months (range 3.5 to 8.3) from time of heel wound
development. No amputation occurred in 6 patients (60%). Among them, intact anterior
tibial inline arterial flow was present in 3, intact posterior tibial inline arterial
flow was present in 6, and heel blush was present in 5. Our results demonstrate that
an open calcaneal branch of the posterior tibial artery is sufficient to heal plantar
heel ulcerations to potentially increase rates of limb salvage.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: June 21, 2020
Footnotes
Financial Disclosure: This study was supported by the Department of Plastic Surgery, MedStar Georgetown University Hospital.
Conflict of Interest: None reported.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American College of Foot and Ankle Surgeons.
