Evaluation of late functional results of patients treated with free muscle flaps for heel defects caused by land-mine explosions.
BACKGROUND
High-energy land-mine explosions cause extensive soft-tissue and bone defects in the heel area, which mostly require free flap coverage. In this article, the authors present the long-term functional outcomes of 72 patients who had free muscle flap reconstructions for composite heel defects caused by land-mine explosions.


METHODS
The composite heel defects of 72 male patients caused by land-mine explosions were reconstructed by means of free muscle flaps. The mean follow-up was 6.5 years (range, 1 to 12 years). Each patient completed a questionnaire rating his level of satisfaction. Dynamic foot pressure distribution testing, three-dimensional motion analysis, and dynamic electromyography were performed for all patients. The data were compared with the control group of 20 volunteers. Statistical analysis was performed by Kruskal-Wallis, Mann-Whitney U, and Wilcoxon tests.


RESULTS
Dynamic pressure distribution tests revealed significantly higher pressure and load in the injured feet of the patients (p < 0.05). Three-dimensional motion analysis showed restricted range of motion at the ankle joints of the injured extremity (p < 0.05). Seventeen patients were able to stand as long as the control group; the mean standing time for the others was 2.85 hours per day (range, 36 minutes to 5.32 hours). Many of the patients (71 percent) declared their satisfaction of having their own feet instead of prostheses.


CONCLUSIONS
This is the longest series documenting the long-term functional results of patients injured by land mines who were treated with free muscle flaps. Reconstructive options should be preferred to amputation procedures in extensive tissue loss caused by land-mine explosion where possible.
Oztürk
Serdar
S
Department of Plastic and Reconstructive Surgery, Gülhane Military Medical Academy, Ankara, Turkey. serozt@yahoo.com
Bayram
Yalcin
Y
Möhür
Haydar
H
Deveci
Mustafa
M
Sengezer
Mustafa
M
D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology; D001696:Biomechanical Phenomena; D001753:Blast Injuries / Q000601:surgery*; D004576:Electromyography; D005107:Explosions; D018409:Foot Injuries / Q000601:surgery*; D005684:Gait; D006365:Heel / Q000293:injuries*; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D013524:Surgical Flaps