• Hokuto Morii, Takahiro Inui, Hiroki Shibayama, Kazunori Oae, Fumio Onishi, Takuya Hashimoto, Koichi Inokuchi, and Makoto Sawano.
• Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan. Electronic address: ho9101117@saitama-med.ac.jp.
• Injury. 2023 Aug 1; 54 (8): 110826110826.

BackgroundPatients with heel pad degloving injury frequently develop ischemic necrosis of the area, necessitating soft-tissue reconstruction surgery. We have developed a technique for arterialization of the plantar venous system via vein graft (APV) as the primary revascularization treatment. The objective of this study was to clarify both the utility of APV for the preservation of degloved heel pads and the impact of this preservation on clinical outcomes.MethodsTen consecutive cases of degloving injury with devascularized heel pad were treated at a single trauma center from 2008 to 2018. Five cases underwent APV and five underwent conventional primary suture (PS) as the initial treatment. We evaluated the course according to the frequency of heel pad preservation, additional intervention after heel pad necrosis, post-operative complications, and outcomes using the Foot and Ankle Disability Index score (FADI) at the time of last follow-up.ResultsAmong the five cases that underwent APV, the heel pad was preserved in three cases and flap surgery was required in two cases. All cases that underwent PS developed necrosis of the heel pad, requiring skin graft in one case and flap surgery in four. One skin graft case and one free flap case after PS developed plantar ulcers. The three cases with preserved heel pads exhibited higher FADI than the seven cases that developed necrosis.ConclusionAPV showed a relatively high frequency of heel pad preservation, which otherwise was uniformly lacking. Functional outcomes were improved in cases with preserved heel pad compared to those that developed necrosis and underwent additional tissue reconstruction.Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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