Outcomes of Primary Repair of Heel Pad Degloving Injuries

OBJECTIVES: To report the outcomes of patients with heel pad degloving injuries, and to identify patient, injury, or treatment factors associated with successful repair. METHODS: Design: Retrospective cohort study Setting: Single level 1 academic trauma center Patient Selection Criteria: All patients admitted with an acute heel pad degloving injury between 2005-2024 were included. Outcome Measures and Comparisons: The primary outcome was successful repair of a heel pad degloving injury. Univariate analysis was performed to examine risk factors for primary repair failure. RESULTS: Fifty-eight patients with acute heel pad degloving injuries were included, of whom fifty were male with average age of 35 years (range 6-69, SD 17). Forty patients were treated with an attempt at primary repair, three were treated primarily with a flap, and 15 were treated with primary amputation. Primary repair was successful in 15 patients (38%). Repair method (suture alone, augmentation with k-wires, incisional wound vac) was not associated with repair success (p>0.05 for all). Of the patients with failed primary repair, 6 underwent secondary amputation, while 19 underwent attempted salvage with a flap (13), skin graft (5), or dermal substitute (1). Of the 19 with attempted salvage, 10 (53%) had complications including persistent ulceration, infection, and/or wound breakdown. Two of this cohort underwent secondary amputation. No patients in the successful primary repair group underwent later amputation. CONCLUSIONS: The rate of success after attempted primary repair of heel pad degloving injuries was 38% in this series. The rate of secondary amputation was 20%. Augmenting primary repair with suture anchors or k-wires, or addition of a wound vac, was not significantly associated with improved success rates in univariate analysis, although these findings are limited by the retrospective nature of the study. Skin and soft tissue necrosis was the reason for failure of primary repair in all cases. Future studies may consider using techniques such as indocyanine green angiography to assess heel pad perfusion and identify patients at risk for failure of primary repair. Finally, although complication rates after failed primary repair were high, ultimately most limbs that underwent secondary flap reconstruction were able to be salvaged. LEVEL OF EVIDENCE: III