A 74-year-old female patient with longstanding type 2 diabetes was admitted to the hospital because of a stroke. She had palsy of her left arm and foot. Her hos-pitalization was complicated by aspiration pneumonia, which confined the patient to bed for 2 weeks. The patient had a history of ischemic heart disease and hypertension. peripheral pulses were weak in both feet. on the sixth day of her hospitalization a blister with a black base developed on the posterolateral aspect of her left foot, and it evolved into an ischemic ulcer and dry gangrene (Figure 7.3). A triplex ultrasonogram revealed extensive severe bilateral stenoses in the superficial femoral and popliteal arteries. Revascularization was not possible due to the patient's general condition. A heel protector ring was applied so that the heel was completely suspended off the bed and sharp debridement was performed. The ulcer healed after 4 months with daily foot care.
pressure ulcers are caused by constant pressure over bony heel prominences from an opposing surface such as a mattress. This results in reduced blood flow in the heel with soft tissue necrosis and consequent pressure ulcer development. These ulcers may account for extended hospitalizations and they are recognized as both detrimental to an individual's quality of life and a financial burden to the healthcare system. pressure ulcers of the heel are preventable by the use of a heel protector ring (Figure 7.4) or other calf support devices (Figure 7.5). Since the calf has a large resting surface
excessive pressure is avoided. In addition, revascularization should be performed immediately in patients with heel gangrene, since such ulcers heal slowly and may become infected.
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