Compressed Fixation Combined with Vacuum-Assisted Closure for Treating Acute Injury of the Heel Fat Pad

Abstract

BackgroundTreating acute injury of the heel fat pad is different from treating common soft tissue damage. Due to the paucity of literature on the topic, we described our initial experience treating acute injury of the heel fat pad to determine the ideal treatment method.Material/MethodsA total of 53 patients with acute injury of the heel fat pad admitted to our hospital were selected for the study and were randomly divided into 2 groups: the compressed fixation combined with vacuum-assisted closure group and the only reimplanted and sewn group. Twenty-seven of the heel fat pads were compressed and fixed using a flat, hard piece of plastic and hollow screws; then, they were covered with a vacuum-assisted closure device. The other 27 were only sewn without tension. The clinical results were evaluated according to the American Orthopedic Foot and Ankle Society hindfoot score and the British Medical Research Council function evaluation criteriaResultsIn the compressed fixation combined with vacuum-assisted closure group, flaps of 12 feet with retrograde avulsion injury survived successfully. Partial flap necrosis occurred in 8 feet. Seven feet underwent repair using the neurocutaneous vascular resupinated island flap. Results were excellent or good for 74% of patients according to the AOFS. However, in the only reimplanted and sewn group, results were excellent or good for 44% of patients according to the AOFS.ConclusionsCompressed fixation with vacuum-assisted closure is effective for treating acute injury of the heel fat pad, with high success rates and good utility.

Repair of avulsion flap injury of heel by multiple point anchorage using Kirschner wires-a case series

“…Complete or partial necrosis and secondary surgery are inevitable. 3 Two patients in our study who were chronic smokers developed skin edge necrosis that was debrided and healing thereafter went uneventful (Figure 4). There were two patients with recently diagnosed diabetes that was controlled on medications and did not cause any wound healing problems.…”

“…Excessive clearing of the injured fat tissue was also avoided. 3 The skin wound was not sutured and a light compressive dressing was then applied.…”

“…The structure of the heel pad is complex, with collagenous elements connecting the plantar fascia to the heel derma and collagen-reinforced chambers filled with fatty tissue restricting its displacement when subjected to compressive loading and maintaining the integrity of the heel pad that can be considered an independent hydrostatic structure that supports, buffers, absorbs shock, and prevents sliding. [1][2][3][4] Heel pad is supplied posteriorly by the medial calcaneal branch of the posterior tibial artery with a variable contribution from the lateral calcaneal branch of the peroneal artery. The anterior part of the heel is supplied primarily by the lateral plantar artery with a reliable contribution from the medial plantar artery (Figure 1).…”

“…5 There is rich anastomosis between these vessels at 2 levels in the heel-subdermal and periosteal but the compartments of fat confined between the fibrous septa were almost avascular and thus prone to develop liquefactive necrosis after injury. 3 Degloving injuries of heel pad are uncommon with incidence of 2.26% of all foot injuries but are very difficult to treat. The modalities of the management of a degloving injury of the sole and heel are as follows.…”

Management of Partial Heel Pad Avulsion using Multiple Kirschner wire Anchorage Technique – Case Report

“…The heel pad is a specialized adipose-based structure that helps in weight-bearing in the heel strike phase of the gait mechanism. The main functions of the heel pad include prevention of sliding, shock absorption, and weight-bearing [ 5 ]. The elastic fibrous septa in the heel pad are arranged in a honeycomb pattern with compact fat cells.…”