A Plantar Defect Healing Outcome Using Secondary Intention

In this study, the authors (Caroline Asirvatham Gjorup and Peter Stemann Andersen) share a case report that describes the management of a plantar defect after surgical resection of a melanoma on the weightbearing heel. The wound was then managed with negative pressure wound therapy (NPWT) for 4 weeks, until granulation tissue was flush with the surrounding skin.1 This study (Excellent outcome of healing by secondary intention after wide local excision of the weight-bearing heel) was published on March 8, 2022, with the JPRAS Open.

A 54-year-old-man presented to the authors and was diagnosed with an T3b (Breslow tumor thickness 2.5 mm and ulceration) acral melanoma on the lateral part of the right weightbearing heel. The authors performed wide local excision with a lateral excision margin of 20 mm, deep resection to the plantar fascia, and sentinel lymph node biopsy (SLNB) of the popliteal fossa.

The authors state that this method was chosen to replace with like tissue. The defect was treated with NPWT with a setting of –125 mm Hg and a compression bandage. Within 5 days of the surgery, the NPWT was changed to another NPWT system (setting of -80 mm Hg), which was changed every 3 to 5 days. Within 4 weeks, the defect measured 40 × 45 mm, the granulation tissue was flush with the surrounding skin, and the NPWT was then ceased. The wound was completely healed after 16 weeks.

The authors conclude that healing by secondary intention is an acceptable treatment option for the closure of large plantar defects, despite being an overlooked reconstructive option. The treatment consisted of healing by secondary intention with NPWT and dressing changes, until wound closure was achieved. Healing by secondary intention was a benefit to the patient’s quality of life; and the functional and cosmetic outcome of the surgical removal was excellent.

To read the full study, click here.

—Cat Urbanski, Associate Digital Editor

Reference

1. Gjorup CA, Andersen PS. Excellent outcome of healing by secondary intention after wide local excision of the weight-bearing heel. JPRAS Open. 2022;32:178-181. Published 2022 Mar 8. doi:10.1016/j.jpra.2022.02.009