Soft Tissue Reconstruction Strategy of Spontaneous Calcaneal Fracture in a Patient with Diabetic Penetrating Foot Ulcer

Author Info

Alessandro Torre Laura De Pellegrin Marta Teglas Marco De Monti

Corresponding Author

Marco De Monti
EOC - Beata Vergine Regional Hospital, Department of Surgery, Mendrisio, Switzerland

A B S T R A C T

Background: Spontaneous pathologic fractures of the calcaneum in diabetic patients are rarely described in the literature. The pathologic fractures following osteomyelitis represent a possibly limb-threatening condition and if associated with a concomitant calcaneal ulcer, they present defiance for the surgeon and furthermore an outstandingly challenging condition to handle. Methods: A 61-year-old diabetic female patient on insulin therapy has been treated for a penetrating foot ulcer. In sequence the following procedures were carried out: Negative pressure wound therapy with instillation and dwell time (NPWTi-d), Negative Pressure Wound Therapy (NPWT), arterial percutaneous angioplasty (PTA), calcanectomy and temporary arthrodesis, application of Dermal Regeneration Template (DRT) and transplantation of microfractured autologous adipose graft (LIPOGEMS®), treatment of residual dehiscence with physical cold plasma (kINPen®MED). Results: The patient completely healed within 20 months and was able to walk without further aids. Conclusion: The authors point to the promptness within the treatment of pathologic calcaneal fractures, whether throughout the usage of technical devices targeting the reduction of the bacterial load and stimulation of healthy tissue, like in NPWTi-d and kINPen®MED. The use of a dermal regeneration template followed by skin grafting enriched with autologous microfractured adipose tissue (LIPOGEMS®), therefore represents today the most advanced regenerative surgical procedures.

Article Info

Article Type

Case Report and Review of the Literature

Publication history

Received: Mon 01, Aug 2022
Accepted: Tue 16, Aug 2022
Published: Wed 07, Sep 2022

Copyright

© 2023 Marco De Monti. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.AJSCR.2022.02.03