01989nas a2200301   4500000000100000008004100001260001700042653001500059653001000074653001000084653001100094653001500105653000900120653001100129653001200140653000900152653001600161653001600177653002200193653002100215100001700236245005400253300001100307490000700318050003200325520131600357022001401673       2005                            d  c2005 Jul-Sep10aAdolescent10aAdult10aChild10aFemale10aFoot Ulcer10aHeel10aHumans10aleprosy10aMale10aMiddle Aged10aRadiography10aSuture Techniques10aTissue Expansion1 aMalaviya G N00aClosure of simple heel ulcers by skin stretching.  a255-650 v77  aInfolep Library - available3 a<p>A majority of heel ulcers, at least to begin with, extend to dermis or to the fat pad in its superficial part and an appropriate skin closure can heal these ulcers as most of the padding is in tact. Since the skin is adherent to the deeper structures with fibrous bands it has to be stretched or undermined (by cutting the fibrous bands) to close the wound without tension. 17 feet in 11 patients (10 males; one female) in the 12-54 year age-group were operated upon and followed up. Because skin is adherent to deeper tissues by fibrous septae, stretching of skin was planned to mobilize it for a tension-free closure. Of the 17 feet, 13 could be re-examined after 30 months or more. Most of the minor recurrences were seen in the first 6 months after surgery. Major recurrences were seen in 2 feet (one case). The suture line did not show hyperkeratosis and the scar merged well into the surrounding skin after one year. Available data suggest that simple heel ulcers can be made to heal with a good scar by skin-stretching and suture, and, by radiography of the foot, it is worth separating those cases in which ulcer is not extending deep involving calcaneum. The size of the ulcer in heel is important for the success of the operation. The procedure is not intended for big wounds (>15 mm in width).</p>  a0254-9395