THE DIFFICULT HEEL WOUND
Wounds located on a patients heel, either on the back or on the bottom; present a unique difficult to heal situation. These usually come to our office after treatment by other specialists is not adequate for wound closure. We realize that these particular wounds are difficult to off load and allow the body to heal the wound. The other problem in this area is that the overall vasculature, the blood flow to the skin is minimal when compared to other places in the lower extremity. These two factors create the perfect opportunity for a chronic wound to develop. Also in this area, there is bone ( the Calcaneus aka the heel bone ) that is very close to the skin surface. A chronic wound can easily introduce bacteria to the surface of the bone and cause a bone infection called osteomyelitis ( if you would like to know more about Bone Infections click here or navigate to the osteomyelitis tab to the left ).
We use all the newest techniques of wound closure- proxiderm and dermaclose to mechanically pull the wound closed, plastic surgical muscle and skin flap rotation to acheive immediate wound closure. Partial bone debridements may be necessary to remove infected bone. In certain cases of this we use an ilizarov distraction osteogenesis technique to grow the patient a new heel bone altogether! We perform all debridements necessary, usually done in the office and do use the techniques of total contact casting in those situations where we believe it will help.
If you have a heel wound that cannot be healed please contact us, no matter how small or extensive the wound may be, we will devise a treatment plan for you. If you live out of the New York area we can direct you to a doctor in your area that we trust.
A little bit more about diabetic decubitus ulcers and other pressure ulcers:
Over the years the number of heel ulcers have steadily increased, partly due to an aging population and those diseases such as diabetes and peripheral vascular arterial disease. Approximatly 2 million people develop a heel ulcer every year, Many of these are PREVENTABLE! Particular care should be given to prevent these in the bedridden patients, patients who undergo orthopedic type of surgery such as hip fracture or hip replacement, or vascular surgery. Those patients who suffer from incontinece, dementia, malnutrition need to be monitored. Monitoring is as simple as dialy checkup on area of prominence such as the back of the heel. These wounds generally start as bluish or reddish appearance of skin in areas of increased pressure. Another area that must be inspected is the lateral ankle or the outside of the ankle where the fibula or ankle bone ends. this is also a common area for pressure ulceration. As part of the overall examination nutritional testing needs to be performed and since you generally are what you eat a nutritional consultation and supplementation may be necessary to promote healing. Treatment should include careful nursing care (i.e. turning patients every two hours especially to prevent sacral ulcerations, appropriately lubricating the skin), nutrition and hydration, mobility, pain management and meticulous wound care, including medical and surgical interventions. In cases where ulcerations have developed special offloading boots may need to be applied, this is very important and should be monitored not only by the doctors and nurses but the FAMILY as well. Educating both the patient and family is critical and should be an ongoing effort.
A Helpful Guide To Pressure Ulcer Classifications :
Classifying or staging pressure ulcers can be confusing as there are many different classification systems. The National Pressure Ulcer Advisory Panel (NPUAD) formulated guidelines that could function as a universal model. The panel offers the following four-stage system of classifying these lesions.
Grade One: This grade is characterized by non-blanchable erythema on intact skin. Discoloration of the skin, warmth, edema, induration or hardness may also be indicators, particularly in individuals with darker skin tones.
Grade Two: This stage represents a partial thickness skin loss involving epidermis, dermis or both. The ulcer is superficial and presents clinically as an abrasion or blister.
Grade Three: This stage represents a full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to but not through the underlying fascia.
Grade Four: These lesions reveal extensive destruction, tissue necrosis or damage to the muscle, bone or supportive structures with or without full thickness skin loss.