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Vascular assessment of heel pressure ulcers

David Bosanquet Surgeon University Hospital of Wales spoke at today’s Eliminating Heel Pressure Ulcers conference on:

  • Ensuring vascular assessment
  • Arterial intervention for heel pressure ulcers
  • Other surgical options

David Bosanquet's full presentation is available for download at the end of this page.

David commented: 

‘If you can feel pulses in the foot – this means you have adequate blood supply’

‘if we are going to intervene we will do either a duplex, CT or MRI’

‘Research has shown heel wounds are harder to heal than other wounds’

‘Sometimes its best to give patient tiny amputation if bed bound’

‘I think invaluable that all patients should have dopplers’

‘In a sense all pressure ulcers are avoidable’

‘If you have a patient with diabetes – blood vessels are hard. Toe pressure is the way to find out if patient has a pressure ulcer’

‘We would love not to have to operate unless absolutely clear cut that patient has pressure ulcer’

In his presentation David States: 

“What is going through vascular surgeons head? Two problems – pressure and blood flow, Harder than other pedal wounds, Takes longer to heal, Cost more, More failures and More postop mortality. Should I intervene? Pt comorbidities, Nutritional status, Life expectancy and Pt/family wishes. Can I intervene? Angioplasty and Open surgery”

“Angioplasty vs bypass surgery - Generally angioplasty for milder disease, open surgery for more significant. RCTs suggest surgery better if life expectancy >2 years (IP PU mortality- 70% at 180 days). If multi-level disease – might need both”

“Conclusions - Use duplex, exam and ABPI to ID PVD pts, Grade II-IV heel PU with PVD – vascular referral, Revascularisation options are either endovascular or open, Debridement/calcanectomy alternatives and is timely amputation good option”

Abstract of David’s presentation

Adequate vascular assessment of heel pressure ulcers is essential in identifying which patients have significant peripheral vascular disease (PVD) and therefore warrant input from a vascular surgeon.  Whilst many patients may have occult PVD without any symptoms, development of a heel pressure ulcer in a patient with pre-existing PVD will almost invariably mandate vascular intervention.  Bedside assessment includes palpating for pulses, assessing doppler signals and performing ABPIs.  Prior to any planning for intervention, arterial imaging is required, which may be duplex, CT, MR, or percutaneous angiography.  The decision to intervene in patients with PVD and heel pressure ulcers depends on myriad factors, including the patients overall health, as well as specific patterns of disease.  Intervention is either endovascular or open surgery.  Whilst the endovascular approach is generally preferable in frail patients, some may be suitable candidates for open surgery.  Other, sometimes more specialist, surgical techniques for managing heel pressure ulcers include debridement, calcanectomy, or free flap usage.  Occasionally a major amputation, either below or above the knee, is preferable to risky major surgery in patients with major co-morbidities.

David qualified from Cardiff Medical School with commendation in 2006.  He did his foundation and core surgical training in South Wales, before completing an MD with Professor Keith Harding in the biology of Wound Healing.  He is currently a senior registrar in vascular surgery.  His professional roles include Rouleaux Club (vascular trainees society) representative, Association of Surgeons in Training representative, member of the Welsh Barbers Research Group and the Vascular and Endovascular Research Network.  

Future events of interest:

Eliminating Avoidable Pressure Ulcers
Wednesday 2 December 
Manchester Conference Centre, Manchester

Nurse Prescribing for Wound Care
Tuesday 19 January 
Hallam Conference Centre, London


Download: David Bosanquet full presentation

24 September 2015

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