{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:56:11Z","timestamp":1791618971849,"version":"4.3.4"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T00:00:00Z","timestamp":1649376000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Non\u2010healing plantar weight\u2010bearing heel ulcers are a challenging problem to treat. Free tissue transfer (FTT) reconstruction of the heel is an opportunity for limb salvage to preserve gait and ambulation. The aim of this study is to describe surgical and functional outcomes in patients who underwent FTT to treat chronic heel ulcers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review of patients who underwent FTT for plantar heel ulcers from 2011 to 2021 was conducted. Patient demographics, comorbidities, perioperative data, postoperative complications, and long\u2010term outcomes were recorded. Primary outcomes included flap success, complications, postoperative ambulation, patient\u2010reported outcome measures and limb salvage, with patients stratified into limb salvage or eventual amputation groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Forty\u2010four patients underwent 45 heel reconstructions. Average age and BMI were 57.3\u2009years and 30.1\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , respectively. Thirty\u2010eight patients (86.4%) had calcaneal osteomyelitis, 35 patients (79.5%) had diabetes, and 18 patients (40.9%) had peripheral vascular disease (PVD). Immediate microsurgical success rate was 95.6%. At mean follow\u2010up of 19.6\u2009\u00b1\u200920.9\u00a0months, overall limb salvage rate was 73.3% (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a033). Preoperative albumin levels were higher in limb salvage group compared to the amputation group (3.0 vs. 2.4\u00a0g\/dl,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.018). Prior stroke history and hypoalbuminemia were significantly higher in the amputation group compared to limb salvage group (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.012 and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.018, respectively). Risk for eventual amputation was associated with PVD (OR 4.0,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.053), hypoalbuminemia (OR 4.9,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.020), and postoperative infection (OR 6.3,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.013). Of the 12 amputations that occurred, the most common indication for amputation was infection (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a08, 66.7%), which most often occurred at the original wound location (62.5%). At most recent follow\u2010up, 90.7% of patients (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a039) were ambulatory.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>FTT is an effective alternative to amputation in patients with chronic heel ulcers. Proper patient selection, preoperative optimization, and postoperative care are imperative to the success of this limb salvage procedure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.30889","type":"journal-article","created":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T09:05:39Z","timestamp":1649408739000},"page":"538-547","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Free flap reconstruction of plantar\n                    <scp>weight\u2010bearing<\/scp>\n                    heel defects:\n                    <scp>Long\u2010term<\/scp>\n                    functional and\n                    <scp>patient\u2010reported<\/scp>\n                    outcomes"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7998-5970","authenticated-orcid":false,"given":"Adaah A.","family":"Sayyed","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery MedStar Georgetown University Hospital  Washington District of Columbia USA"},{"name":"Georgetown University School of Medicine  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2192-1143","authenticated-orcid":false,"given":"Parhom","family":"Towfighi","sequence":"additional","affiliation":[{"name":"Georgetown University School of Medicine  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4551-7436","authenticated-orcid":false,"given":"Romina","family":"Deldar","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery MedStar Georgetown University Hospital  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7114-6275","authenticated-orcid":false,"given":"Christopher E.","family":"Attinger","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery MedStar Georgetown University Hospital  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1056-2114","authenticated-orcid":false,"given":"Karen K.","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery MedStar Georgetown University Hospital  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,4,8]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000222582.84385.54"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2021.01.004"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/79.4.371"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000006791"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12416"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30253"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1675145"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1571249"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/1457496914524389"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0037-1621736"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30658"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0950-821X(88)80067-7"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1579536"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2015.04.004"},{"issue":"6","key":"e_1_2_7_16_1","first-page":"212","article-title":"Heel ulcerations in the diabetic patient","volume":"14","author":"Kerstein M. 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