A REGIONAL PEDAL ISCHEMIA SCORING SYSTEM FOR DECISION-ANALYSIS IN PATIENTS WITH HEEL ULCERATION

PURPOSE: The objective of this study was to evaluate patients undergoi ng operative debridement for heel ulceration and to categorize pedal p erfusion and its influence on therapeutic alternatives. METHODS: Patie nts with heel ulceration were stratified by arteriography and graded I (patent posterior tibial, PT), II (occluded PT/reconstituted from per oneal), III (PT reconstituted from dorsal pedal), IV (no PT reconstitu tion but visible heel tributaries), and V (avascular heel). RESULTS: F rom May 1992 through January 1997, 23 patients underwent operative tre atment for 25 heel ulcers, The heel ischemia score stratified patients into two groups: 1, revascularization/ debridement (71% grades I to I II, 29% grade IV, 0% grade V); and 2, free tissue transfer with or wit hout revascularization (100% grades IV, V). Cumulative functional limb salvage was 91% (BP), 60% (BP+TT), and 81% (TT) at 24 months (P = 0.1 5 log rank). CONCLUSION: The heel ischemia score may direct treatment of heel ulceration by identifying patients who will need vascularized tissue transfer early in their treatment regimen. Am J Surg. 1998;176: 109-114. (C) 1998 by Excerpta Medica.