Partial calcanectomy in high-risk patients with diabetes: use and utility of a "hurricane" incisional approach

Abstract

Introduction: Plantar heel ulcers in people with diabetes represent a difficult challenge to the treating physician. They become even more difficult with underlying osteomyelitis. When this infection is in the calcaneus it typically results in a partial or total calcanectomy or even more frequently, high-level amputation.

Methods: In this article, we describe a novel serpentine incisional approach to the plantar and (if necessary) posterior heel allowing for ample exposure and facilitating closure predominantly along relaxed skin tension lines.

Results: We present several representative case examples in which a hurricane incision has been used to treat and provide closure to plantar-based calcaneal ulcers.

Discussion: The use of this incision, which resembles a satellite view of a hurricane, was successful in achieving a desired partial calcanectomy and wound closure. This may be an additional tool in the armamentarium of the surgeon to assist in healing and amputation prevention.

Figure 1

(a) Approach to Hurricane incision. (b) Exposure of the calcaneus after full-thickness dissection.

Figure 1

(a) Approach to Hurricane incision. (b) Exposure of the calcaneus after full-thickness dissection.

Figure 2

(a) Lateral radiograph showing plantarflexion of distal calcaneus causing the plantar ulceration. (b) Clinical picture of ulceration prior to surgical intervention. (c) First postoperative visit. (d) Wound healed at 6 weeks.

Figure 2

(a) Lateral radiograph showing plantarflexion of distal calcaneus causing the plantar ulceration. (b) Clinical picture of ulceration prior to surgical intervention. (c) First postoperative visit. (d) Wound healed at 6 weeks.

Figure 2

(a) Lateral radiograph showing plantarflexion of distal calcaneus causing the plantar ulceration. (b) Clinical picture of ulceration prior to surgical intervention. (c) First postoperative visit. (d) Wound healed at 6 weeks.

Figure 2

(a) Lateral radiograph showing plantarflexion of distal calcaneus causing the plantar ulceration. (b) Clinical picture of ulceration prior to surgical intervention. (c) First postoperative visit. (d) Wound healed at 6 weeks.

Figure 3

(a) Clinical picture of ulceration prior to surgical intervention. (b) Postoperative picture showing closure of ulceration. (c) Wound healed 2 months following partial calcanectomy with “hurricane” incision.

Figure 3

(a) Clinical picture of ulceration prior to surgical intervention. (b) Postoperative picture showing closure of ulceration. (c) Wound healed 2 months following partial calcanectomy with “hurricane” incision.

Figure 3

(a) Clinical picture of ulceration prior to surgical intervention. (b) Postoperative picture showing closure of ulceration. (c) Wound healed 2 months following partial calcanectomy with “hurricane” incision.