Management of massive traumatic compound defects of the foot

Abstract

The management of high-energy trauma to the foot often requires multiple tissues reconstructive procedures with various technical options. The authors report the case of a patient presenting an extensive defect of the medioplantar region of the right foot involving an almost complete (90%) medial cuneiform bone loss. A deferred operation with saphenous cross-leg flap and interposition of a cement spacer was first performed. Reconstruction of the bone defect with corticocancellous iliac bone graft was subsequently carried out at two months post-trauma. At four months follow-up, the bone and soft tissues healing were good. At 24 months follow-up, the patient could return to normal professional and sports activities. The saphenous cross-leg flap has proven to be a reliable reconstructive procedure. The use of the modified Masquelet technique ensured an anatomical reconstruction and a satisfying final functional outcome.

Cross-Leg Flaps for Lower Extremity Salvage: A Scoping Review

“…There were only 10 publications, including 80 of 409 patients, where the indication or contraindication was unknown. 16,18,[23][24][25][26][27][28][29][30][31] Forty-one publications, including 329 of 409 patients, noted a contraindication to free tissue. Long et al 22 listed the indication for cross-leg flap as being a simple and effective solution in reconstruction (n ¼ 3), while Sharma and Kola 32 listed cross-leg flap as being a reliable and simpler alternative to microsurgery (n ¼ 6).…”

“…Typically, lower extremity cross-leg flaps were used to cover the middle (n ¼ 36 of 272, 13.2%) and distal third of the leg (n ¼ 151 of 272, 55.5%), or the foot (n ¼ 76 of 272, 27.9%). Size of defect was mentioned in 13 publications, 12,15,25,26,30,41,[45][46][47][48]51,57,59,63 including 142 patients, with a wide range of 12 to 360 cm 2 . Wound VAC preparation was mentioned as the wound prep method in five publications 12,26,52,57,63 including a minimum of eight patients, with debridement as the wound prep method mentioned in 21 publications 13,14,22,26-28,30 36,39,41,44-46,51,53,55,58-60,64,65 Fig.…”

“…19 publications). 6,11,19,24,31,32,36,38,40-42,51,53,54,57 59,61-63 External fixators were the immobilization method used in 57.7% of cases (26 publications, n ¼ 184 of 319) of the cases, 6,12,15,20,22,[26][27][28]30,31,37,39,40,43,[46][47][48][49]52,54,55,57,60,61,63,64 with plaster cast 11,14,18,32,36,38,42,44,50,53,65 (33.2%, 11 publications, n ¼ 106 of 319), or other immobilization method being much less frequent. Pedicles were typically divided at 3 weeks (mean 20.9 days, range: 11-42 days).…”

“…Pedicles were typically divided at 3 weeks (mean 20.9 days, range: 11-42 days). Skin grafts were used to close the donor site 86.7% of the time (n ¼ 242 of 279, 32 publications) 6,11,[13][14][15]21,22,25,26,28,[30][31][32][33][34]36,38,40,[43][44][45][46][47][48][49][50][51]53,54,59,62,63 with primary closure less common (13.3%, n ¼ 37 of 279, 6 publications), 18,23,25,39,40,53 when the donor site closure was discussed.…”

“…The next most common complications were infection (n ¼ 10 of 350, 2.9%), osteomyelitis (n ¼ 7 of 350, 2.0%), skin graft loss at either the flap or donor site (n ¼ 4 of 350, 1.1%), venous congestion (n ¼ 2 of 350, 0.6%) and ulceration, shearing, deep vein thrombosis (DVT), and hypertrophic scar mentioned in one case each. 6,12,14,17,18,20,25,[30][31][32]34,[37][38][39][40][41][42][43]52,[58][59][60]64 Two-third of publications commented on mobility or ambulatory status, with ability to ambulate (n ¼ 240 patients, 29 publications) 6,12,16,18,19,22,23,26,29,31,36,37,39,[41][42][43][44]46,52,[55][56][57][58][59][60]…”