Repair of high-energy-induced tissue defects of the dorsal foot by free muscle transfer and skin graft.
Various alternative methods have been used for repair of extensive dorsal foot defects due to high-energy-induced injuries. The authors reconstructed such defects with free muscle transfers and skin grafts in 9 male patients (average age, 21.7 years) between the years 1995 and 1998. Patients (right foot, 5; left foot, 4) presented with injuries due to military rifle gunshot (N = 4), mine explosion (N = 2), high-voltage electricity (N = 2), and traffic accident (N = 1). The patient injured in a traffic accident was treated with skin grafting only, and experienced osteomyelitis and skin breakdown. The other 8 patients were injured acutely and were hospitalized within 3 weeks of injury. After serial debridement of necrotic tissues, surgery was performed at an average of 6 weeks postinjury. Metatarsal bone defects of 5 cm in 3 patients were repaired by iliac (N = 2) and fibular (N = 1) bone grafts. Free muscle latissimus dorsi (N = 4) and rectus abdominis (N = 5) flaps were transferred microsurgically. The transferred muscle flaps were covered with split-thickness skin grafts. Mean operation duration was 5 hours 12 minutes. All flaps survived. The average area of soft-tissue defect repaired was 93 cm2 (range, 36-231 cm2). Average follow-up was 25 months. No symptoms of osteomyelitis and skin breakdown were encountered in the 8 acutely injured patients. Monofilament sensory tests revealed diminished protective sensation in 5 patients and absence of protective sensation in 4 patients. Partial resorption of bone grafts occurred in 2 patients. Thinning of the flaps was performed by tangential excision in 2 patients whose muscle flaps did not diminish in thickness. All patients were able to wear normal shoes. The authors suggest the use of free muscle transfer in reconstructing extensive soft-tissue defects of the dorsal foot.
Department of Plastic, Reconstructive Surgery, Gülhane Military Medical Academy, Ankara, Turkey.
S
S
Işik
B
B
Celiköz
M
M
Demiroğullari
M
M
Sengezer
N
N
Selmanpakoğlu
D000063:Accidents, Traffic; D000328:Adult; D001753:Blast Injuries / Q000601:surgery; D016025:Bone Transplantation; D003131:Combined Modality Therapy; D003646:Debridement; D004556:Electric Injuries / Q000601:surgery; D018409:Foot Injuries / Q000601:surgery*; D005545:Forefoot, Human / Q000293:injuries / Q000601:surgery; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery; D016038:Skin Transplantation; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps; D014948:Wounds, Gunshot / Q000601:surgery