Chronic wounds of the heel can be some of the most difficult conditions to treat in lower extremity reconstruction. Unlike other areas of the foot and ankle, the heel has very limited soft tissue coverage, meaning there is little natural fat or muscle to protect the bone underneath. When a wound becomes long-standing, recurrent, or infected, healing becomes even more challenging—and in some cases, the patient may even face the possibility of amputation.
This case highlights the advanced limb salvage techniques used by Dr. Kevin Lam to successfully reconstruct a complex heel wound that had persisted for two decades.
The Challenge: A 20-Year Chronic Lateral Calcaneal Wound
This patient presented with a chronic wound on the lateral aspect of the calcaneus (heel bone) that had been present for approximately 20 years. Over time, the wound would intermittently flare up, causing repeated episodes of inflammation and breakdown.
Chronic wounds in this region often develop due to:
Previous calcaneal fractures
Surgical complications
Infected hardware or implants
Chronic pressure or trauma
Deep tissue damage involving bone
Because the heel does not have significant fat or muscle padding, wounds in this location can quickly become severe. When infection reaches the bone (osteomyelitis), it creates an even greater barrier to healing.
Why Heel Wounds Are So Difficult to Heal
Standard wound care methods such as:
debridement (cleaning dead tissue)
antibiotics
skin substitutes
skin grafts
may be helpful, but they often fail when there is not enough healthy tissue underneath the wound.
A skin graft requires a stable and well-vascularized bed to survive. If the wound is over exposed bone or chronically infected tissue, the graft may not take. This is where advanced reconstruction becomes critical.
The Solution: Peroneal Muscle Flap Reconstruction
To provide the wound with the best chance of healing and long-term durability, Dr. Kevin Lam recommended a peroneal muscle flap as part of a limb salvage approach.
A muscle flap is valuable because it brings:
strong blood supply
infection-fighting healing potential
durable coverage over bone
soft tissue padding in an area that lacks it
By transferring local muscle tissue into the wound defect, the reconstruction creates a biologically active environment capable of supporting closure and healing.
Advanced Limb Salvage Approach: Ilizarov Fixation, Skin Graft, and Wound VAC
In addition to the peroneal muscle flap, this case was treated with a comprehensive reconstruction strategy including:
Ilizarov External Fixation
This method provides stability and offloading while allowing the foot and ankle to remain properly aligned during healing.
Skin Grafting
Once a healthy tissue bed was established, a skin graft was applied to provide final surface coverage.
Wound VAC Therapy
Negative pressure wound therapy (wound VAC) was used to:
support graft adherence
reduce swelling
improve blood flow
accelerate wound closure
This combination approach is often necessary for complex wounds where long-term success depends on both soft tissue coverage and biomechanical stability.
The Outcome: Healed, Functional, and Back to Normal Life
Following surgery and adherence to postoperative protocols, the patient healed successfully.
Today, the patient is:
fully healed
back to work
walking comfortably
wearing normal sneakers again
For both the patient and the surgical team, limb salvage cases like this represent the reward of combining experience, technique, and persistence to achieve a life-changing result.
When Muscle Flaps Are Essential
Many chronic wounds can be treated with routine wound care, but certain cases require reconstruction.
A muscle flap may be necessary when:
bone is exposed
chronic infection is present
there is poor soft tissue coverage
prior grafting or wound care has failed
amputation risk becomes a concern
The muscle provides coverage and protection that other methods cannot replace.
Expertise Matters in Complex Limb Salvage
Complex heel wounds are not routine cases. Successful limb salvage requires a surgeon with experience in both wound reconstruction and advanced lower extremity procedures.
Dr. Kevin Lam specializes in complex foot and ankle reconstruction, chronic wound management, and limb salvage surgery—helping patients preserve function, mobility, and quality of life even in challenging cases.
Schedule a Consultation
If you or a loved one is dealing with a chronic non-healing wound, recurrent infection, or has been told amputation may be necessary, advanced reconstruction options may still be available.
Consult with Dr. Kevin Lam to explore modern limb salvage solutions and personalized treatment options.
Call (239) 430-3668 (FOOT)
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