Page 67 - Read Online

Original Article Plastic and Aesthetic Research

Heel pad avulsion injury: an approach with

hyperbaric oxygen therapy

Pradeoth Korambayil Mukundan, Prashanth Varkey Ambookan

Department of Plastic Surgery and Burns, Jubilee Institute of Surgery for Hand, Aesthetic and Microsurgery, Jubilee Mission Medical
College and Research Institute, Thrissur 680007, Kerala, India.
Address for correspondence: Dr. Pradeoth Korambayil Mukundan, Flat No. 102, Nandana, Haritha Gardens, Vadookara, Thrissur 680007,
Kerala, India. E-mail: pradeoth@gmail.com

ABSTRACT
Aim: Crush injuries of the foot are often associated with partial or complete degloving of the heel
pad. The purpose of this study is to present an algorithm for the management of various types of
heel pad avulsion injuries, including hyperbaric oxygen (HBO) therapy in the treatment regimen.
Methods: We present a prospective study of 27 patients with various types of heel pad avulsion
managed in our institution from December 2012 to June 2013. Heel pad avulsion injuries were
classified according to the angiosomal pattern. Partial or complete avulsions were classified and treated
accordingly. HBO therapy was administered postoperatively. The postoperative period, hospital
course, and follow-up were documented in patients with heel pad avulsion injuries. Results: Of
27 patients, 20 cases presented with partial avulsion and 7 cases were complete avulsion. Of 20 cases
of partial avulsion, one of the flaps was anchored with K-wire. Nineteen cases of partial heel pad
avulsion were managed by suturing. Eight patients out of 20 required skin grafting as a secondary
procedure at a later date. Out of 7 cases of complete avulsion, one was managed by full-thickness skin
grafting, one case by reverse sural artery flap coverage, and four cases were managed by free tissue
transfer. No flap revisions were required, and no complications were experienced for the transferred
flaps. Conclusion: HBO therapy may be a useful adjunct in the treatment of heel pad avulsion injuries.

Key words:
Angiosome, heel pad avulsion, hyperbaric oxygen therapy, soft tissue reconstruction

INTRODUCTION to be complete and may require removal of the avascular
tissue and reconstruction with local or distant flaps.
Foot trauma is a significant cause of morbidity among the Providing sensate and glabrous skin may not be possible
working age population. Crush injuries to the foot are in patients with extensive injuries. There are clinical
[2]
often associated with avulsion injuries of the heel pad. situations in which the avulsed heel pad structure may be
Heel pad avulsion injuries are always a challenge for the viable, requiring debridement and anchoring of the heel
plastic surgeons, as the reconstructed tissue, even though pad flap in position. In cases of partial avulsion, the heel
sensate, may not match the unique and complex nature pad is, usually, debrided, reattached in position by sutures
of the native fat pad structure. Heel pad avulsion injuries or K‑wire fixation, and further surgical interventions are
[1]
may be partial or complete. When the avulsed heel pad postponed until there has been a demarcation of the
tissue is avascular or clinically nonviable, avulsion is said nonviable tissue. As the heel pad tissue is irreplaceable,
[1]
there is a need for alternative methods of preserving the
Access this article online
marginal tissue as well as preventing ischemia and hypoxic
Quick Response Code: advancement of the injured tissue. In this prospective
Website:
www.parjournal.net study, various treatment modalities including hyperbaric
oxygen (HBO) therapy, primary closure, full thickness skin
grafting/split thickness skin grafting (FTSG/STSG), and local
DOI:
10.4103/2347-9264.153200 or distant flap coverage were utilized to preserve and
reconstruct the valuable heel pad tissue.

56 Plast Aesthet Res || Vol 2 || Issue 2 || Mar 13, 2015