J Korean Foot Ankle Soc.  2025 Mar;29(1):41-45. 10.14193/jkfas.2025.29.1.41.

Combined Treatment of Negative Pressure Wound Therapy and Temporary Tension Suture for Intractable Hindfoot Ulcer with Chronic Osteomyelitis: A Case Report

• Kim J
• Yun JH
• Kang J

• KMID: 2565871
• DOI: http://doi.org/10.14193/jkfas.2025.29.1.41

Abstract

The heel is the second most common area for pressure injuries, which can lead to serious and threatening extremity infections. The late stages of deep hindfoot ulcers, where osteomyelitis commonly coexists, can result in an extended therapeutic window. Standard treatments for hindfoot ulcers complicated by osteomyelitis encompass debridement and flap surgery. In severe cases, below-knee amputation is also considered. Recent studies have reported the efficacy of negative pressure wound therapy (NPWT) in addressing refractory foot ulcers. The authors developed a temporary tension suture (TTS) in combination with NPWT to shorten the treatment duration of refractory foot ulcers, providing additional appropriate tension for wound coverage. The authors report for the first time a case of a 73-year-old female patient who had been experiencing an intractable hindfoot ulcer with chronic osteomyelitis for 18 months. NPWT and TTSs were applied concurrently with favorable outcomes.

Keyword

Foot; Hindfoot; Ulcer; Negative pressure wound therapy; Temporary tension suture

Figure

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  Figure 1 Sagittal T2-weighted magnetic resonance image of L-spine (A). Axial T2-weighted magnetic resonance image of L4-5 level (B) and L5-S1 level (C). The magnetic resonance images show severe central canal stenosis at the L4-5 level (B) and moderate neural foraminal stenosis at the L5-S1 level (C).

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  Figure 2 The initial radiographs of right foot (A, B). Osteolytic lesion and deformity of calcaneus are visible.

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  Figure 3 Sagittal T2-weighted magnetic resonance image (A) and sagittal T2-weighted fat suppressed magnetic resonance image (B) of right foot. The magnetic resonance images show bone marrow edema and subacute fracture of right calcaneus bone.

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  Figure 4 Bone scintigraphy images show changes suggestive of osteomyelitis that reveal localized hot uptake on delayed phase. Early phase (A) and delayed phase (B).

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  Figure 5 Sequential clinical photographs of heel ulcer. At the first visit, there was an ulcer on the right heel, and no bone exposure through the ulcer (A). These are photographs of treatment using NPWT (negative pressure wound therapy) and TTS (temporary tension suture) at the 2nd (B), 3rd (C), and 4th (D) weeks from the first visit. The wound was almost completely healed at 9 weeks (E), and this is a follow-up photo taken at 1 year (F).

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