Long-term Outcomes Of Reconstruction For Weight-bearing Heel Ulcers Using Free Tissue Transfer
Romina Deldar, MD1, Adaah Sayyed, BS2, Parhom Towfighi, BS2, Christopher E. Attinger, MD1, Karen K. Evans, MD1.
1MedStar Georgetown University Hospital, Washington, DC, USA, 2Georgetown University School of Medicine, Washington, DC, USA.
PURPOSE: Non-healing plantar weight-bearing heel ulcers are a challenging problem to treat. Free tissue transfer (FTT) is an opportunity for limb salvage of the heel to preserve gait and ambulation. The aim of this study is to describe surgical and functional outcomes in patients who underwent FTT to treat heel ulcers.METHODS: A retrospective review of patients who underwent FTT for plantar heel ulcers from 2011-2021 was conducted. Patient demographics, comorbidities, perioperative data, complications, and long-term outcomes were recorded. Primary outcomes included flap success, complications, postoperative ambulation, and limb salvage.RESULTS: Forty-eight patients were identified. Average age and BMI were 57.1 years and 30.1 kg/m2, respectively. Forty-one patients (85.4%) had calcaneal osteomyelitis. Immediate microsurgical success rate was 93.8%. At mean follow-up of 22.4 months (range 0.4-111.8 months), overall limb salvage rate was 70.8%. Preoperative albumin levels were higher in limb salvage group compared to amputation group (2.98 vs 2.56, p=0.042). Peripheral vascular disease, diabetes, and prior stroke were significantly higher in the amputation group compared to limb salvage group. Flap infection, dehiscence, and partial flap necrosis were significantly associated with eventual amputation (p=0.029, p=0.037, p=0.037, respectively). 87.5% of patients were ambulatory at follow-up. CONCLUSION: FTT is an effective alternative to amputation in patients with chronic heel ulcers. Proper patient selection, preoperative optimization, and postoperative care are imperative to the success of this limb salvage procedure.
| Variable | Flap Success | Flap Loss | p-value | Limb Salvage | Amputation | p-value |
| PVD | 20 (44.4%) | 1 (33.3%) | 0.595 | 11 (32.4%) | 10 (71.4%) | 0.015 |
| Diabetes | 36 (80%) | 3 (100%) | 0.498 | 26 (76.5%) | 13 (92.9%) | 0.033 |
| Albumin (g/dL) | 2.9+0.7 | 2.9+0.5 | 0.908 | 2.98+0.65 | 2.56+0.56 | 0.042 |
| Patent PT or peroneal artery | 11 (24.4%) | 0 (0%) | 0.704 | 7 (20.6%) | 4 (28.6%) | 0.723 |
| Angiogram intervention | 17 (37.8%) | 0 (0%) | 0.260 | 12 (35.3%) | 5 (35.7%) | 0.614 |
| Dehiscence | 7 (15.6%) | 1 (33.3%) | 0.429 | 3 (8.8%) | 5 (35.7%) | 0.037 |
| Infection | 12 (26.7%) | 1 (33.3%) | 0.622 | 6 (17.6%) | 7 (50%) | 0.029 |
| Partial Flap Necrosis | 6 (13.3%) | 2 (66.6%) | 0.068 | 3 (8.8%) | 5 (35.7%) | 0.037 |
| Ambulatory | 40 (88.9%) | 2 (66.7%) | 0.336 | 32 (94.1%) | 10 (71.4%) | 0.052 |
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