J Terrence Jose Jerome1, Simon Thomas. 1. Department of Orthopedics, St Stephen's Hospital, Tiz Hazari, Delhi 54, India. terrencejose@gmail.com
Abstract
BACKGROUND: The purpose of the report was to present a 45-year-old lady who had a chronic osteomyelitis right calcaneum with a large non-healing ulcer and discharging sinus, treated by split-heel incision of Gaenslen. OBJECTIVES: Patients who have a recurrent ulcer of the heel often have a below-the-knee amputation because durable soft tissue coverage cannot be obtained over the calcaneus. Often, even if the ulcer heals satisfactorily or the area appears to be revascularized as a result of a peripheral vascular procedure, the resulting surface is not durable and the ulcer recurs. Gaenslen's technique is recommended for refractory cases or patients with a draining sinus centrally located on the plantar aspect of the heel. An excellent functional result can be obtained. METHOD: Calcaneum was divided from posterior to anterior with a broad osteotome and split into two halves to expose the interior of the bone. Sequestra, infected material, necrotic slough damaged cortex were removed. The wound was closed loosely with a drain in situ. RESULT: The pressure sore and the surgical wound healing were remarkable at the end of 6 weeks. The heel had a deeply situated surgical scar and over which the surrounding tissues were laid, thus forming thick cushions. CONCLUSIONS: Split-heel incision of Gaenslen removed all sequestra, obviously infected matter and did little damage to the cortex. The resultant scar was painless and was so deeply situated that the tissues on either side curl inward to form 'cushions'.
BACKGROUND: The purpose of the report was to present a 45-year-old lady who had a chronic osteomyelitis right calcaneum with a large non-healing ulcer and discharging sinus, treated by split-heel incision of Gaenslen. OBJECTIVES:Patients who have a recurrent ulcer of the heel often have a below-the-knee amputation because durable soft tissue coverage cannot be obtained over the calcaneus. Often, even if the ulcer heals satisfactorily or the area appears to be revascularized as a result of a peripheral vascular procedure, the resulting surface is not durable and the ulcer recurs. Gaenslen's technique is recommended for refractory cases or patients with a draining sinus centrally located on the plantar aspect of the heel. An excellent functional result can be obtained. METHOD: Calcaneum was divided from posterior to anterior with a broad osteotome and split into two halves to expose the interior of the bone. Sequestra, infected material, necrotic slough damaged cortex were removed. The wound was closed loosely with a drain in situ. RESULT: The pressure sore and the surgical wound healing were remarkable at the end of 6 weeks. The heel had a deeply situated surgical scar and over which the surrounding tissues were laid, thus forming thick cushions. CONCLUSIONS: Split-heel incision of Gaenslen removed all sequestra, obviously infected matter and did little damage to the cortex. The resultant scar was painless and was so deeply situated that the tissues on either side curl inward to form 'cushions'.