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A 60-year-old man with severe
diabetes, vascular disease, and previous left below
knee amputation developed a large heel ulcer while
hospitalized. He was offered, and refused, right
leg amputation. The issues of arterial disease and
anatomical location once again make conventional
grafts and flaps unworkable, but Integra reliably
solves what conventional modalities cannot. A large
posterior calcanectomy was performed. The osteotomy
and achilles insertion were closed with Integra,
seen here as a face on view of the healed reconstruction.
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His toes were also missing from
previous vascular problems, but enough foot remained
to permit stable weight bearing, stance, and gait.
He is seen here, in full upright, weight bearing
on the healed foot. This profile view shows the
extent of the oblique calcanectomy, which merely
followed the contours of skin necrosis.
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For stability, the patient uses
a space filling orthotic wrapped around his ankle
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Using a normal sneaker, his left
leg prosthesis, and a walker, he is independent
and ambulatory. A complex problem was solved with
no donor sites, no risk to foot or patient, excellent
biological healing, and preservation of function
and lifestyle, all as an outpatient. For many of
these challenging problems, Integra is an ideal
option, working where other modalities of wound
management have failed.
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Cases Courtesy of:
Marc E. Gottlieb, M.D., Jennifer Furman
Journal of Burns and Wounds, Vol 3, #2
