{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T15:08:17Z","timestamp":1770908897732,"version":"3.50.1"},"reference-count":28,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2011,9,23]],"date-time":"2011-09-23T00:00:00Z","timestamp":1316736000000},"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":["International Wound Journal"],"published-print":{"date-parts":[[2012,4]]},"abstract":"<jats:p>In many series of diabetic foot ulcer care, heel ulcers greater than 4 cm across have been identified as an independent predictor of limb loss. Therefore, we set out to pursue the most aggressive limb salvage algorithm in patients with heel ulcers greater than 4 cm in diameter. Over 5 years, we identified 21 patients, 39\u201384 years of age, all with diabetes mellitus, with heel ulcers greater than 4 cm in diameter and had magnetic resonance imaging or bone scan evidence of osteomyelitis. Seven of the 21 patients had end\u2010stage renal disease defined as being haemodialysis dependent. All patients had ankle brachial indices &lt;0\u00b74 or monophasic pulse volume recordings. All patients underwent distal bypass surgery with vein. After adequate perfusion was obtained, all patients underwent partial calcanectomy and intra\u2010operative negative pressure wound therapy (NPWT) placement. This was followed by treatment with recombinant platelet\u2010derived growth factor (PDGF). One patient underwent amputation during the healing process secondary to ongoing sepsis. Twenty of 21 patients healed acutely (within 6 months). Three of 20 patients went on to subsequent below knee amputation within 12 months of healing primarily. At 2 years, 12 of 21 (57%) were ambulating independently, 1 of 21 was dead, 4 of 21 had undergone amputation, 4 (19%) had limbs that were intact but were not ambulating. A total limb salvage rate of 76% at 2 years mirrored the secondary patency rates, with 100% follow up. Heel ulcers require multimodality therapy if they are going to have any chance to heal. We believe the algorithm presented allows for the required revascularisation and a modulation of the heel ulcer microenvironment by augmenting the microcirculation through NPWT, and improving the proliferative capacity with PDGF.<\/jats:p>","DOI":"10.1111\/j.1742-481x.2011.00869.x","type":"journal-article","created":{"date-parts":[[2011,9,27]],"date-time":"2011-09-27T20:22:47Z","timestamp":1317154967000},"page":"132-138","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Multimodal therapy as an algorithm to limb salvage in diabetic patients with large heel ulcers"],"prefix":"10.1111","volume":"9","author":[{"given":"Ewan B.","family":"Goudie","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cynthia","family":"Gendics","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"II","given":"John C","family":"Lantis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2011,9,23]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.1990.tb01405.x"},{"key":"e_1_2_5_3_2","volume-title":"Healthy people 2010: understanding and improving health.","author":"U.S. Department of Health and Human Services.","year":"2000"},{"key":"e_1_2_5_4_2","first-page":"642","volume-title":"The evidence base for diabetes care.","author":"Reiber GE","year":"2002"},{"key":"e_1_2_5_5_2","unstructured":"AttingerC.Limb Salvage vs. amputation: a patient\u2010centric approach.The American College of Wound Healing and Tissue Repair Inaugural Meeting 2011 Chicago IL USA August 4\u20135."},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2009.02.226"},{"key":"e_1_2_5_7_2","unstructured":"2011 National Diabetes Fact Sheet.http:\/\/www.cdc.gov\/diabetes\/pubs\/factsheets11.htm. 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