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Outcomes of Partial Calcanectomy in an Academic Limb Salvage Center: A Multicenter Review

Published:September 14, 2022DOI:https://doi.org/10.1053/j.jfas.2022.07.007

      Abstract

      Chronic nonhealing heel ulcerations have been established as an independent risk factor for major amputation, with poor rates of limb salvage success. Partial calcanectomy is a controversial limb salvage procedure reserved for patients with these heel ulcerations. We conducted a retrospective cohort study reviewing 39 limbs that underwent a partial calcanectomy from 2012 to 2018 to evaluate the proportion of patients healed, time to healing, ulcer recurrence, and postoperative functional level compared to the preoperative state. In addition, age, gender, body mass index, smoking status, coronary artery disease, diabetes mellitus, renal insufficiency, dialysis, peripheral arterial disease, method of closure, and percent of calcaneus resected were evaluated. Mean follow-up for our cohort was 2.3 years. We had a 1 year mortality rate of 11%, and a major amputation rate of 18%. Our results demonstrated a 77% healing rate with a median time to healing of 162 days. We found that patients who were closed primarily had a faster time to healing compared to patients who underwent closure by secondary intention. Our data showed that ulcer recurrence developed in 57% of healed limbs. We found that 76% of our patients were ambulatory postoperatively. These results suggest that partial calcanectomy is a viable limb salvage procedure with a predictable level of ambulation and function in a high-risk patient population.

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      References

      1. International Diabetes Federation. IDF Diabetes Atlas 10th Edition. Available at:http://www.diabetesatlas/org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf. Accessed December 2021.

        • Yazdanpanah L
        • Shahbazian H
        • Nazari I
        • Arti HR
        • Ahmadi F
        • Mohammadianinejad SE
        • Cheraghian B
        • Hesam S
        Incidence and risk factors of diabetic foot ulcer: a population-based diabetic foot cohort (ADFC study)—two-year follow-up study.
        Int J Endocrinol. 2018; 2018: 1-9
        • Sing N
        • Armstrong DJ
        • Lipsky BA
        Preventing foot ulcers in patients with diabetes.
        JAMA. 2005; 2: 217-228
        • Bauer K
        • Rock K
        • Nazzal M
        • Jones O
        • Qu W
        Pressure ulcers in the United States’ inpatient population from 2008 to 2012: results of a retrospective Nationwide Study.
        Ostomy Wound Manage. 2016; 62: 30-38
        • Fowler E
        • Scott-Williams S
        • McGuire JB
        Practice recommendations for preventing heel pressure ulcers.
        Ostomy Wound Manage. 2008; 54: 42-57
        • Barczak CA
        • Barnett RI
        • Childs FJ
        • Bosley LM
        Fourth national pressure ulcer survey.
        Adv Wound Care. 2005; 10: 8-26
        • Cevera JJ
        • Bolton LL
        • Kerstein MD
        Options for diabetic patients with chronic heel ulcers.
        J Diabetes Complications. 1997; 11: 358-366
        • Younes NA
        • Albsoul AM
        • Awad H
        Diabetic heel ulcers: a major risk factor for lower extremity amputation.
        Ostomy Wound Manage. 2004; 50: 50-60
        • Bosanquet DC
        • Wright AM
        • White RD
        • Williams IM
        A review of the surgical management of heel pressure ulcers in the 21st century.
        Int Wound J. 2015; 13: 9-16
        • Tukiainen E
        • Kallio M
        • Lepäntalo M
        Advanced leg salvage of the critically ischemic leg with major tissue loss by vascular and plastic surgeon teamwork.
        Ann Surg. 2006; 244: 949-958
        • Carsen 3rd, CG
        • Taylor SM
        • Langan 3rd, EM
        • Crane MM
        Factors associated with limb loss despite a patent infrainguinal bypass graft.
        Am Surg. 1998; 64: 33-37
        • Faglia E
        • Clerici G
        • Caminiti M
        • Curci V
        • Somalvico F.
        Influence of osteomyelitis location in the foot of diabetic patients with transtibial amputation.
        Foot Ankle Int. 2013; 34: 222-227
        • Moon KC
        • Kim KB
        • Han SK
        • Jeong SH
        • Dhong ES.
        Risk factors for major amputation on hindfoot ulcers in hospitalized diabetic patients.
        Adv Wound Care. 2018; 00: 1-9
        • Aulivola B
        • Hile CN
        • Hamdan AD
        • Sheahan MG
        • Veraldi JR
        • Skillman JJ
        • Campbell DR
        • Scovell SD
        • LoGerfo FW
        • Pomposelli Jr., FB
        Major lower extremity amputation: outcome of a modern series.
        Arch Surg. 2004; 139: 395-399
        • Thorud JC
        • Plemmons B
        • Buckley CJ
        • Shibuya N
        • Jupiter DC.
        Mortality after nontraumatic major amputation among patients with diabetes and peripheral vascular disease: a systematic review.
        J Foot Ankle Surg. 2016; 55: 591-599
        • Jupiter DC
        • Thorud JC
        • Buckley CJ
        • Shibuya N.
        The impact of foot ulceration and amputation on mortality in diabetic patients. I: From ulceration to death, a systematic review.
        Int Wound J. 2015; 13: 892-903
        • Medianer A
        Medianer fersenchnitt.
        Centralbl F Chir. 1896; XXIII: 857
        • Gaenslen FJ.
        Split-heel approach in osteomyelitis of os calcis.
        J Bone Joint Surg. 1931; 13: 759-772
        • Elmarsafi T
        • Pierre A
        • Wang K
        • Evans KK
        • Attinger CE
        • Kim PJ
        • Steinberg JS.
        The vertical contour calcanectomy: an alternative surgical technique to the conventional partial calcanectomy.
        J Foot Ankle Surg. 2018; 00: 1-6
        • Schade V.
        Partial or total calcanectomy as an alternative to below-the-knee amputation for limb salvage: a systematic review.
        J Am Podiatr Med Assoc. 2012; 102: 396-405
        • Cook J
        • Cook E
        • Landsman AS
        • Basile P
        • Dinh T
        • Lyons T
        • Rosenblum B
        • Giurini J.
        A retrospective assessment of partial calcanectomies and factors influencing postoperative course.
        J Foot Ankle Surg. 2007; 46: 248-255
        • Walsh TP
        • Yates BJ.
        Calcanectomy: avoiding major amputation in the presence of calcaneal osteomyelitis—a case series.
        Foot. 2013; 23: 130-135
        • Bollinger M
        • Thordarson DB.
        Partial calcanectomy: an alternative to below knee amputation.
        Foot Ankle Int. 2002; 23: 927-932
        • Lin CT
        • Chen SG
        • Chen TM
        • Chang SC.
        Partial calcanectomy facilitates wound closure of heel defects in high-risk patients.
        Ann Plast Surg. 2016; 76: 688-692
        • Paola LD
        • Carone A
        • Boscarino G
        • Scavone G
        • Vasilache L.
        Combination of open subtotal calcanectomy and stabilization with external fixation as limb salvage procedure in hindfoot-infected diabetic foot ulcers.
        Int J Low Extrem Wounds. 2016; 15: 332-337
        • Babiak I
        • Pędzisz P
        • Kulig M
        • Janowicz J
        • Małdyk P.
        Comparison of bone preserving and radical surgical treatment in 32 cases of calcaneal osteomyelitis.
        J Bone Joint Surg. 2016; 1: 10-16
        • Van Riet A
        • Harake R
        • Stuyck J.
        Partial calcanectomy: a procedure to cherish or to reject?.
        Foot Ankle Surg. 2012; 18: 25-29
        • Randall DB
        • Phillips J
        • Ianiro G.
        Partial calcanectomy for the treatment of recalcitrant heel ulcerations.
        J Am Podiatr Med Assoc. 2005; 95: 335-342
        • Akkurt M
        • Demirkale I
        • Öznur A.
        Partial Calcanectomy and Ilizarov external fixation may reduce amputation need in severe diabetic calcaneal ulcers.
        Diabetic Foot Ankle. 2017; 8: 1-7
        • Cates NK
        • Wang K
        • Stowers JM
        • Attinger CE
        • Kim PJ
        • Steinberg JS.
        The vertical contour calcanectomy, an alternative approach to surgical heel ulcers: a case series.
        J Foot Ankle Surg. 2019; 58: 1067-1071
        • Oliver NG
        • Steinberg JS
        • Powers K
        • Evans KK
        • Kim PJ
        • Attinger CE.
        Lower extremity function following partial calcanectomy in high-risk limb salvage patients.
        J Diabetes Res. 2015; 2015: 1-7
        • Conte MS
        • Bradbury AW
        • Kolh P
        • White JV
        • Dick F
        • Fitridge R
        • Mills JL
        • Ricco JB
        • Suresh KR
        • Murad MH
        • Aboyans V
        • Aksoy M
        • Alexandrescu VA
        • Armstrong D
        • Azuma N
        • Belch J
        • Bergoeing M
        • Bjorck M
        • Chakfé N
        • Cheng S
        • Dawson J
        • Debus ES
        • Dueck A
        • Duval S
        • Eckstein HH
        • Ferraresi R
        • Ghambir R
        • Gargiulo M
        • Geraghty P
        • Goode S
        • Gray B
        • Guo W
        • Gupta PC
        • Hinchliffe R
        • Jetty P
        • Komori K
        • Lavery L
        • Liang W
        • Lookstein R
        • Menard M
        • Misra S
        • Miyata T
        • Moneta G
        • Prado JAM
        • Munoz A
        • Paolini JE
        • Patel M
        • Pomposelli F
        • Powell R
        • Robless P
        • Rogers L
        • Schanzer A
        • Schneider P
        • Taylor S
        • De Cinga MV
        • Veller M
        • Vermassen F
        • Wang J
        • Wang S.
        Global vascular guidelines on the management of chronic limb-threatening ischemia.
        Eur J Vasc Endovasc Surg. 2019; 58: S1-S109
        • Mills JL
        • Conte MS
        • Armstrong DG
        • Pomposelli FB
        • Schanzer A
        • Sidway AN
        • Andros G.
        The society for Vascular Surgery lower extremity threatened limb classification system: risk stratification based on Wound, Ischemia, and foot Infection (WIfI).
        J Vasc Surg. 2014; 59: 220-234
        • Causey MW
        • Ahmed A
        • Wu B
        • Gasper WJ
        • Reyzelman A
        • Vartanian SM
        • Hiramoto JS
        • Conte MS.
        Society for Vascular Surgery limb stage and patient risk correlate with outcomes in an amputation prevention program.
        J Vasc Surg. 2016; 63: 1563-1573
        • Mathioudakis N
        • Hicks CW
        • Canner JK
        • Sherman RL
        • Hines KF
        • Lum YW
        • Perler BA
        • Abularrage CJ.
        The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system predicts wound healing but not major amputation in patients with diabetic foot ulcers treated in a multidisciplinary setting.
        J Vasc Surg. 2017; 65: 1698-1705
        • Armstrong DG
        • Boulton AJM.
        Diabetic foot ulcers and their recurrence.
        N Engl J Med. 2017; 376: 2367-2375
        • Attinger CE
        • Brown BJ.
        Amputation and ambulation in diabetic patients: function is the goal.
        Diabetes Metab Res Rev. 2012; 28: 93-96
        • Smith DG
        • Stuck RM
        • Ketner L
        • Sage RM
        • Pinzur MS.
        Partial calcanectomy for the treatment of large ulcerations of the heel and calcaneal osteomyelitis. An amputation of the back of the foot.
        J Bone Joint Surg Am. 1992; 74: 571-576
        • Webb P
        • Bain C
        • Page A.
        Observational studies.
        Essential Epidemiology: An Introduction for Students and Health Professionals. 3rd ed. Cambridge University Press, Cambridge2017: 127-128
      2. (edited by)
        • Hulley SB
        • Cummings SR
        • Browner WS
        • Grady D
        • Newman TB
        Designing cross-sectional and cohort studies.
        in: Seigafuse S Winter N Designing Clinical Research. 4th ed. Wolters Kluwer / Lippincott Williams and Wilkins, 2013: 85-96 (edited byPhiladelphia)