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. 2010 Feb 1:10:e17.

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

Timothy K Fisher  1 , David G Armstrong
Affiliations

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

Timothy K Fisher et al. Eplasty. .

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.

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Figures

Figure 1
Figure 1
(a) Approach to Hurricane incision. (b) Exposure of the calcaneus after full-thickness dissection.
Figure 1
Figure 1
(a) Approach to Hurricane incision. (b) Exposure of the calcaneus after full-thickness dissection.
Figure 2
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
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
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
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
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
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
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.
See this image and copyright information in PMC

References

    1. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217–28. - PubMed
    1. Lavery LA, Armstrong DG, Wunderlich RP, Tredwell J, Boulton AJ. Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort. Diabetes Care. 2003;26(5):1435–8. - PubMed
    1. Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29(6):1288–93. - PubMed
    1. Lavery LA, Peters EJG, Armstrong DG, Wendel CS, Murdoch DP, Lipsky BA. Risk factors for developing osteomyelitis in patients with diabetic foot wounds. Diabetes Res Clin Pract. 2009;83:347–52. - PubMed
    1. Perez ML, Wagner SS, Yun J. Subtotal calcanectomy for chronic heel ulceration. J Foot Ankle Surg. 1994;33:572–9. - PubMed

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