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Whilst the vast majority of heel pressure ulcers (PUs) are superficial and involve the skin (stages I and <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content>) or underlying fat (stage <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>), between 10% and 20% will involve deeper tissues, either muscle, tendon or bone (stage <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>). These stage <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> heel PUs represent a major health and economic burden and can be difficult to treat. The worst outcomes are seen in those with large ulcers, compromised peripheral arterial supply, osteomyelitis and associated comorbidities. Whilst the mainstay of management of stage I\u2010<jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> heel pressure ulceration centres on offloading and appropriate wound care, successful healing in stage <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> PUs is often only possible with surgical intervention. Such intervention includes simple debridement, partial or total calcanectomy, arterial revascularisation in the context of coexisting peripheral vascular disease or using free tissue flaps. Amputation may be required for failed surgical intervention, or as a definitive first\u2010line procedure in certain high\u2010risk or poor prognosis patient groups. This review provides an overview of heel PUs, alongside a comprehensive literature review detailing the surgical interventions available when managing such patients.<\/jats:p>","DOI":"10.1111\/iwj.12416","type":"journal-article","created":{"date-parts":[[2015,2,16]],"date-time":"2015-02-16T08:52:39Z","timestamp":1424076759000},"page":"9-16","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["A review of the surgical management of heel pressure ulcers in the 21st century"],"prefix":"10.1111","volume":"13","author":[{"given":"David C","family":"Bosanquet","sequence":"first","affiliation":[{"name":"Regional Vascular Unit University Hospital of Wales  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann M","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Surgery Royal Gwent Hospital  Newport 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