Early Clinical, Functional, and Mortality Outcomes for Heel Ulcers Treated With a Vertical Contour Calcanectomy

Cook, Helene R.; Kennedy, Christopher J.; Delijani, Kevin; Popovsky, Daniel; Elmarsafi, Tammer; Zarick, Caitlin S.; Attinger, Christopher E.; Steinberg, John S.

doi:10.1053/j.jfas.2021.06.015

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…Many of these patients had very large ulcers, peripheral vascular ischemia (56%) and significant systemic comorbidities, for example, diabetes mellitus (86%). 6 This may explain these poorer outcomes in comparison to our series which did not include patients with very large plantar heel ulcers.…”

Section: Discussionmentioning

confidence: 60%

“…This technique has the advantage of treating patients with larger plantar heel ulcers and those with posterior heel ulcers. Cook et al 6 found only 31% of 51 patients were healed without recurrence at 12 months and a major lower limb amputation was required in 31%. Many of these patients had very large ulcers, peripheral vascular ischemia (56%) and significant systemic comorbidities, for example, diabetes mellitus (86%).…”

Section: Discussionmentioning

confidence: 99%

“…Alternative limb-preserving surgical treatments of calcaneal osteomyelitis include using muscle flaps to fill in the bone defect post debridement 12 , 24 and modifications of the partial calcanectomy to improve wound closure. In particular, the vertical contour calcanectomy 4 , 6 , 8 uses a Gaenslen skin incision, and complete detachment of the Achilles tendon and plantar fascia from the calcaneus. Three sequential osteotomies are then performed to (1) remove the weight bearing surface of the calcaneus, (2) remove the tubercle posteriorly, and (3) one at 45 degrees to chamfer the posteroinferior corner.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Follow-up of Complex Calcaneal Osteomyelitis Treated With Modified Gaenslen Approach

Kendal

Loizou

Rees

et al. 2022

Foot & Ankle Orthopaedics

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Background: The treatment of chronic calcaneal osteomyelitis is a challenging and increasing problem because of the high prevalence of diabetes mellitus and operative fixation of heel fractures. In 1931, Gaenslen reported treatment of hematogenous calcaneal osteomyelitis by surgical excision through a midline, sagittal plantar incision. We have refined this approach to allow successful healing and early mobilization in a modern series of complex patients with hematogenous, diabetic, and postsurgical osteomyelitis. Methods: Twenty-eight patients (mean age 54.6 years, range 20-94) with Cierny-Mader stage IIIB chronic calcaneal osteomyelitis were treated with sagittal incision and calcaneal osteotomy, excision of infected bone, and wound closure. All patients received antibiotics for at least 6 weeks, and bone defects were filled with an antibiotic carrier in 20 patients. Patients were followed for a mean of 31 months (SD 25.4). Primary outcome measures were recurrence of calcaneal osteomyelitis and below-knee amputation. Secondary outcome measures included 30-day postoperative mortality and complications, duration of postoperative inpatient stay, footwear adaptions, mobility, and use of walking aids. Results: All 28 patients had failed previous medical and surgical treatment. Eighteen patients (64%) had significant comorbidities. The commonest causes of infection were diabetes ± ulceration (11 patients), fracture-related infection (4 patients), pressure ulceration, hematogenous spread, and penetrating soft tissue trauma. The overall recurrence rate of calcaneal osteomyelitis was 18% (5 patients) over the follow-up period, of which 2 patients (7%) required a below-knee amputation. Eighteen patients (64%) had a foot that comfortably fitted into a normal shoe with a custom insole. A further 6 patients (21%) required a custom-made shoe, and only 3 patients required a custom-made boot. Conclusion: Our results show that a repurposed Gaenslen calcanectomy is simple, safe, and effective in treating this difficult condition in a patient group with significant local and systemic comorbidities. Level of Evidence: Level III, case series.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Long-Term Follow-up of Complex Calcaneal Osteomyelitis Treated With Modified Gaenslen Approach

Kendal

Loizou

Rees

et al. 2022

Foot & Ankle Orthopaedics

View full text Add to dashboard Cite

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Conservative surgery in the management of diabetic foot complications (excluding Charcot). The role of the orthopedic surgeon

Yammine

2024

Journal of Clinical Orthopaedics and Trauma

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Biofilm Formation, Antibiotic Resistance, and Infection (BARI): The Triangle of Death

Giordano,

Giannoudis

2024

JCM

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Fracture-related infection (FRI) is a devastating event, directly affecting fracture healing, impairing patient function, prolonging treatment, and increasing healthcare costs. Time plays a decisive role in prognosis, as biofilm maturation leads to the development of antibiotic resistance, potentially contributing to infection chronicity and increasing morbidity and mortality. Research exploring the association between biofilm maturation and antibiotic resistance in orthopaedics primarily addresses aspects related to quality of life and physical function; however, little exists on life-threatening conditions and mortality. Understanding the intrinsic relationship between biofilm maturation, bacterial resistance, and mortality is critical in all fields of medicine. In the herein narrative review, we summarize recent evidence regarding biofilm formation, antibiotic resistance, and infection chronicity (BARI), the three basic components of the “triangle of death” of FRI, and its implications. Preoperative, perioperative, and postoperative prevention strategies to avoid the “triangle of death” of FRI are presented and discussed. Additionally, the importance of the orthopaedic trauma surgeon in understanding new tools to combat infections related to orthopaedic devices is highlighted.

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Early Clinical, Functional, and Mortality Outcomes for Heel Ulcers Treated With a Vertical Contour Calcanectomy

Cited by 3 publications

References 18 publications

Long-Term Follow-up of Complex Calcaneal Osteomyelitis Treated With Modified Gaenslen Approach

Long-Term Follow-up of Complex Calcaneal Osteomyelitis Treated With Modified Gaenslen Approach

Conservative surgery in the management of diabetic foot complications (excluding Charcot). The role of the orthopedic surgeon

Biofilm Formation, Antibiotic Resistance, and Infection (BARI): The Triangle of Death

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