Partial or Total Calcanectomy as an Alternative to Below-the-Knee Amputation for Limb Salvage

Schade, Valerie L.

doi:10.7547/1020396

Cited by 31 publications

(31 citation statements)

References 48 publications

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“…Of these, 10 were managed with wound dressing and 1 underwent a secondary debridement surgery to remove the residual CS; all of these patients recovered well. In addition, 1 patient died of a cause unrelated to amputation following limb-saving surgery in CO patients ranged from 4% to 20% (Baumhauer et al 1998, Schade 2012, Van Riet et al 2012, Walsh and Yates 2013, Babiak et al 2016. Even a recent study (Waibel et al 2019) showed that 50% of the CO patients had to undergo secondary below-knee amputation even if they had already received total calcanectomy.…”

Section: Infection Eradication Rate and Adverse Eventsmentioning

confidence: 99%

Single-stage debridement with implantation of antibiotic-loaded calcium sulphate in 34 cases of localized calcaneal osteomyelitis

et al. 2020

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Background and purpose — The successful eradication of calcaneus infection with limb salvage remains a challenge. We describe the outcomes of cortical bone windowing followed by eggshell-like debridement and implantation of antibiotic-loaded calcium sulphate (CS) for localized (Cierny–Mader type III) calcaneal osteomyelitis (CO). Patients and methods — We report a retrospective study of 34 patients. Infection followed trauma or orthopedic surgery in 30 patients and hematogenous spread in 4 patients. 31 patients had a sinus tract, accompanied by a soft tissue defect in 3 patients. All patients received cortical bone windowing, debridement, multiple sampling, local implantation of vancomycin- and gentamicin-loaded CS, skin closure or flap coverage, and culture-specific systematic antibiotic treatment in a single-stage procedure. Patients were followed up for a median of 26 months. Results — Infection was eradicated in 29 patients after the single-stage surgery, and all of the 5 recurrent infections were cleared by repeated surgery without amputation. Other adverse events included 11 patients with aseptic wound leakage and 1 unrelated death. Compared with those before surgery, the median postoperative scores of the American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scale (65 vs. 86 vs. 89) and the visual analog scale (VAS) for pain (6 vs. 3 vs. 1) improved at the 1-year and 2-year follow-up. Interpretation — This single-stage protocol, cortical bone windowing, and eggshell-like debridement combined with local implantation of antibiotic-loaded CS is effective in treating type III CO. However, the incidence of aseptic wound leakage is high.

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Section: Infection Eradication Rate and Adverse Eventsmentioning

confidence: 99%

Single-stage debridement with implantation of antibiotic-loaded calcium sulphate in 34 cases of localized calcaneal osteomyelitis

et al. 2020

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“…These data show marked improvement from earlier series, in which there was a significant failure rate with more than 50% of patients requiring amputation or remaining unhealed at 2 years (55). Despite these promising results, these surgical interventions have not been subject to randomised trials, and should be only used in centres with local expertise (54).…”

Section: Management Of Infectionmentioning

confidence: 99%

A review of the surgical management of heel pressure ulcers in the 21st century

Bosanquet

Wright

White

et al. 2015

International Wound Journal

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Heel ulceration, most frequently the result of prolonged pressure because of patient immobility, can range from the trivial to the life threatening. Whilst the vast majority of heel pressure ulcers (PUs) are superficial and involve the skin (stages I and II) or underlying fat (stage III), between 10% and 20% will involve deeper tissues, either muscle, tendon or bone (stage IV). These stage IV heel PUs represent a major health and economic burden and can be difficult to treat. The worst outcomes are seen in those with large ulcers, compromised peripheral arterial supply, osteomyelitis and associated comorbidities. Whilst the mainstay of management of stage I-III heel pressure ulceration centres on offloading and appropriate wound care, successful healing in stage IV PUs is often only possible with surgical intervention. Such intervention includes simple debridement, partial or total calcanectomy, arterial revascularisation in the context of coexisting peripheral vascular disease or using free tissue flaps. Amputation may be required for failed surgical intervention, or as a definitive first-line procedure in certain high-risk or poor prognosis patient groups. This review provides an overview of heel PUs, alongside a comprehensive literature review detailing the surgical interventions available when managing such patients.

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“…The PC is a time-honored alternative to BKA for patients with extensive heel wounds with calcaneal osteomyelitis. Limb salvage with PC should aim to provide a foot capable of ambulation when properly accommodated with a shoe filler and/orthotics [ 2 , 9 , 11 ]. When confronted with the difficult decision of attempted limb salvage versus BKA, careful consideration of patient factors and expectations is paramount to select the option that maximizes QOL, function, and independence.…”

Section: Discussionmentioning

confidence: 99%

“…Schade's systematic review of sixteen retrospective case series included a total of 100 ambulatory patients who underwent PC ( n = 76) or TC ( n = 28) for calcaneal OM [ 2 ]. According to the review, all patients returned to ambulation and 85% of patients maintained or improved their ambulatory status postoperatively.…”

Section: Discussionmentioning

confidence: 99%

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Lower Extremity Function following Partial Calcanectomy in High-Risk Limb Salvage Patients

Oliver

Steinberg

Powers

et al. 2015

Journal of Diabetes Research

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Partial calcanectomy (PC) is an established limb salvage procedure for treatment of deep heel ulceration with concomitant calcaneal osteomyelitis. The purpose of this study is to determine if a relationship exists between the amount of calcaneus removed during PC and the resulting lower extremity function and limb salvage outcomes. Consecutive PC patients were retrospectively divided into two cohorts defined by the amount of calcaneus resected before wound closure: patients in cohort 1 retained = 50% of calcaneus, while patients in cohort 2 underwent resection of >50% of the calcaneus. The Lower Extremity Function Scale (LEFS) was used to assess postoperative lower extremity function. The average amount of calcaneus resected was 13% ± 9.2 (1–39%) and 74% ± 19.5 (51–100) in cohorts 1 and 2, respectively (P < 0.0001). Below knee amputation was performed in 7 (28%) and 5 (29%) of subjects in cohorts 1 and 2, respectively (P = 1.0). The average LEFS score was 33.9 ± 15.0 for subjects in cohort 1 and 36.2 ± 19.9 for the subjects cohort 2 (P = 0.8257) which correlates to “moderate to quite a bit of difficulty.” Our study suggests that regardless of the amount of calcaneus resected, PC provides a viable treatment option for high-risk patients with calcaneal osteomyelitis.

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Partial or Total Calcanectomy as an Alternative to Below-the-Knee Amputation for Limb Salvage

Abstract: This systematic review provides evidence that partial or total calcanectomy is a viable option for limb salvage in ambulatory patients with calcaneal osteomyelitis.

Cited by 31 publications

References 48 publications

Single-stage debridement with implantation of antibiotic-loaded calcium sulphate in 34 cases of localized calcaneal osteomyelitis

Single-stage debridement with implantation of antibiotic-loaded calcium sulphate in 34 cases of localized calcaneal osteomyelitis

A review of the surgical management of heel pressure ulcers in the 21st century

Lower Extremity Function following Partial Calcanectomy in High-Risk Limb Salvage Patients

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