Heel Pressure Ulcers: a study of wound healing

Background

Heels are a common location for pressure ulcers (PUs); they may be physiologically different to other PU sites and their healing is poorly understood.

Aim

To summarise the effects of support surfaces and identify prognostic factors in healing heel PUs.

Objectives

1. Review the effects of support surfaces for heel PU healing
2. Identify factors which independently impact on heel PU healing
3. Describe the characteristics of patients, current management practices and progress of heel PUs

Methods

Systematic review of the evidence of effectiveness for pressure relieving devices in the treatment of heel PUs.
Prospective cohort study of patients with heel PUs ≥ Grade 2 in an acute hospital and followed for 18 months or up till healed.

Results

Systematic review identified 467 potentially relevant articles, retrieved 70 for screening and included 1in a narrative synthesis. No recommendations for practice could be made.

Cohort study recruited 140 people with 183 heel ulcers. 77 (42%) ulcers healed, 88 (48%) did not heal due to death, 5 (3%) were on limbs subsequently amputated, 11 (6%) were unhealed at 18 months, 2 (1%) were lost to follow-up. Cox proportional hazards models identified 12 significant (p≤0.2) variables affecting time to healing in the univariate analysis. Eight entered the multivariate model: 2 reached significance (p≤0.1): severe (cf superficial) ulcers and the presence of (cf the absence) peripheral vascular disease (PVD) reduced the chance of healing.
Ulcer area did not change in a uniform manner. Treatments e.g. support surfaces and dressings were inconsistently used. Many patients experienced non-pressure ulcer related infections during the study.

Conclusion

It is not known if support surfaces aid heel PU healing. The severity of the PU and the presence of PVD are independent prognostic factors for healing. Further work is needed to explore prognostic factors which change over time.