{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:28:12Z","timestamp":1777613292090,"version":"3.51.4"},"reference-count":14,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2013,1,10]],"date-time":"2013-01-10T00:00:00Z","timestamp":1357776000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[2013,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Management of large and deep heel ulcers (LDHUs) is a challenge in patients with diabetic foot lesions. We assessed outcomes of a treatment protocol to save feet with LDHUs from amputation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We managed LDHUs (larger than 3 cm\n                      <jats:sup>2<\/jats:sup>\n                      ) in diabetic feet using a multidisciplinary approach consisting of medical and surgical management, including revascularization and amputation, if necessary. For deep heel infection and\/or gangrene, we frequently debrided and drained the deep spaces of the heel, as needed. In patients with non-ischemic feet, we made a flap from the heel pad with a broad pedicle. When satisfactory granulation tissue covered the base of the heel and the inner surface of the flap, we sutured the heel flap to its base.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We managed 37 feet with LDHUs among 384 patients. Twenty-nine patients (78.4%) had neuropathy, 6 (16.2%) had ischemic diabetic feet, and 2 (5.4%) had both neuropathy and ischemia. Twelve (32.4%) had septic diabetic feet. We performed two femoropopliteal bypasses, 2 infrapopliteal bypasses, and 1 distal bypass (crural) for ischemic heel ulcers. Thirty-three of the 37 feet with heel lesions (89.2%) were salvaged using this multidisciplinary approach. These 33 LDHUs healed after 4 to 7 months (median, 6 months). Transtibial amputation was performed for 4 feet (10.8%; 2 ischemic and 2 neuropathic cases).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Diabetic patients with LDHUs can be managed with a multidisciplinary approach to prevent amputation. If necessary, deep spaces of the heel can be debrided by elevating the heel pad like a flap and then performing satisfactory reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level IV, retrospective case series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1071100712460228","type":"journal-article","created":{"date-parts":[[2013,2,1]],"date-time":"2013-02-01T13:35:21Z","timestamp":1359725721000},"page":"215-221","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Large and Deep Diabetic Heel Ulcers Need not Lead to Amputation"],"prefix":"10.1177","volume":"34","author":[{"given":"Abolfazl","family":"Shojaiefard","sequence":"first","affiliation":[{"name":"Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Research Center for Improvement of Surgical Procedures and Outcomes, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhamak","family":"Khorgami","sequence":"additional","affiliation":[{"name":"Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Research Center for Improvement of Surgical Procedures and Outcomes, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad Reza","family":"Mohajeri-Tehrani","sequence":"additional","affiliation":[{"name":"Endocrinology and Metabolism Research Center (EMRC) Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bagher","family":"Larijani","sequence":"additional","affiliation":[{"name":"Endocrinology and Metabolism Research Center (EMRC) Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2013,1,10]]},"reference":[{"key":"bibr1-1071100712460228","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.1993.tb01003.x"},{"key":"bibr2-1071100712460228","doi-asserted-by":"publisher","DOI":"10.1016\/S1067-2516(99)80052-0"},{"key":"bibr3-1071100712460228","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.24.9.1686"},{"key":"bibr4-1071100712460228","unstructured":"Carsten C, Taylor S, Langan E, Crane M. 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