Assuntos
Doença de Darier/diagnóstico , Calcanhar/patologia , Doença de Darier/terapia , Humanos , Lactente , MasculinoRESUMO
A majority of heel ulcers, at least to begin with, extend to dermis or to the fat pad in its superficial part and an appropriate skin closure can heal these ulcers as most of the padding is in tact. Since the skin is adherent to the deeper structures with fibrous bands it has to be stretched or undermined (by cutting the fibrous bands) to close the wound without tension. 17 feet in 11 patients (10 males; one female) in the 12-54 year age-group were operated upon and followed up. Because skin is adherent to deeper tissues by fibrous septae, stretching of skin was planned to mobilize it for a tension-free closure. Of the 17 feet, 13 could be re-examined after 30 months or more. Most of the minor recurrences were seen in the first 6 months after surgery. Major recurrences were seen in 2 feet (one case). The suture line did not show hyperkeratosis and the scar merged well into the surrounding skin after one year. Available data suggest that simple heel ulcers can be made to heal with a good scar by skin-stretching and suture, and, by radiography of the foot, it is worth separating those cases in which ulcer is not extending deep involving calcaneum. The size of the ulcer in heel is important for the success of the operation. The procedure is not intended for big wounds (>15 mm in width).
Assuntos
Úlcera do Pé/cirurgia , Calcanhar , Hanseníase/complicações , Expansão de Tecido , Adolescente , Adulto , Criança , Feminino , Úlcera do Pé/diagnóstico por imagem , Úlcera do Pé/patologia , Calcanhar/diagnóstico por imagem , Humanos , Hanseníase/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Técnicas de SuturaRESUMO
We have seen 55 trophic ulcers of the heel in 2 years in our hospital, between March 2000 and February 2002. Thirty-four were chronic heel sinuses, six cases of multiple sinuses and 28 cases of single sinus of the plantar aspect of the heel. All these cases were treated by excision of the sinus, paring the prominence of the calcaneum, or excision of the cavity within the calcaneum and coverage by a rotation flap or a modification of this flap. Over the past 6 years, we have evolved a modification of a rotation flap that requires a fusiform incision to excise the sinus, and a curved incision for the flap extending through the instep and the non-weight bearing heel. The fusiform excision, rather than the traditional triangulation, causes the flap to partly transpose rather than rotate completely. The flap is raised superficial to the plantar aponeurosis, exposing the aponeurosis from mid-sole to the heel. It is a modification of a rotation flap. The scarring over the weight-bearing sole is minimal, restricted only to the incision necessary for the excision of the heel sinus and this is its main advantage. Twenty-one of the 34 cases healed without complications. Thirteen cases had complications, of which six were treated non-operatively and seven required either a redo of the flap or another flap cover.
Assuntos
Úlcera do Pé/cirurgia , Calcanhar/cirurgia , Hanseníase Virchowiana/cirurgia , Retalhos Cirúrgicos , Doença Crônica , Humanos , Índia , CicatrizaçãoAssuntos
Humanos , Articulação do Tornozelo/anormalidades , Articulação do Tornozelo/cirurgia , Deformidades do Pé/cirurgia , Deformidades do Pé/fisiopatologia , Deformidades do Pé/reabilitação , Pé Torto/cirurgia , Pé Torto/reabilitação , Traumatismos do Pé/cirurgia , Traumatismos do Pé/reabilitação , Articulação Talocalcânea/anormalidades , Articulação Talocalcânea/cirurgia , Calcanhar/anormalidadesRESUMO
Twenty-four leprous patients with longstanding ulcer of the weight bearing area of the heel underwent reconstruction by use of fasciocutaneous island flap from the instep. One flap was lost because the vascular pedicle was accidentally severed during the dissection. Infection delayed healing in three cases, and one patient developed minor necrosis of the edge of the flap without any adverse consequences. The remaining 18 cases healed without complications. Follow-up of 14 patients 3 to 10 months after the operation showed excellent results in all but the one whose flap was lost. The operation is recommended for difficult reconstructions of the heel.
Assuntos
Úlcera do Pé/cirurgia , Calcanhar/cirurgia , Hanseníase Virchowiana/cirurgia , Transplante de Pele/métodos , Retalhos Cirúrgicos/métodos , Adolescente , Adulto , Idoso , Etiópia , Fáscia/patologia , Fáscia/transplante , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Músculos/patologia , Músculos/transplante , Transplante de Pele/patologia , Retalhos Cirúrgicos/patologia , CicatrizaçãoAssuntos
Calcanhar/cirurgia , Cicatrização , Etiópia , Fáscia/patologia , Fáscia/transplante , Hanseníase/cirurgia , Músculos/patologia , Músculos/transplante , Retalhos Cirúrgicos/métodos , Retalhos Cirúrgicos/patologia , Seguimentos , Sobrevivência de Enxerto , Transplante de Pele/métodos , Transplante de Pele/patologia , Úlcera do Pé/cirurgiaRESUMO
This study presents two cases of Squamous Cell Carcinomas arising from trophic ulcers of leprosy attending Leprosy Department, Government General Hospital, Madras. The aim of this presentation is to analyse these cases in the light of the earlier reports and to draw attention to certain significant features of them.
Assuntos
Carcinoma de Células Escamosas/etiologia , Úlcera da Perna/complicações , Hanseníase/complicações , Neoplasias de Tecidos Moles/etiologia , Calcanhar , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The incidence, causes, clinical presentation and management of ulcers of heel in the insensitive feet of leprosy patients are described. It is pointed out that heel ulcers usually arise as the result of injury and infection and are eminently preventable. Various surgical and non-surgical measures needed for preventing recurrence of the ulcer are also discussed.