title: Strategies for managing massive defects of the foot in high-energy combat injuries of the lower extremity.
abstract: Blast-related lower extremity trauma presents many challenges in its management that are not frequently experienced in high-energy civilian trauma. Because many of the blasts experienced in the current conflicts are ground based, the foot and ankle have sustained considerable severity and extent of injury because of the proximity of the blast. The high functional demands required of active service members create several reconstructive challenges. The authors' experience in the current conflicts has shown a similar trend, with the magnitude of soft tissue injury usually dictating whether or not salvage may be possible. Several reconstructive options for bone defect management are outlined and discussed.
authors.affiliation: Orthopaedic Surgery Service, National Naval Medical Center, Bethesda, MD 20889-5600, USA. john.keeling@med.navy.mil
authors.forename: John J
authors.initials: JJ
authors.lastname: Keeling
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Hsu
authors.forename: Scott B
authors.initials: SB
authors.lastname: Shawen
authors.forename: Romney C
authors.initials: RC
authors.lastname: Andersen
mesh_terms: D001753:Blast Injuries / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008887:Military Medicine / Q000592:standards / Q000639:trends; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D018570:Risk Assessment; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply*; D014857:Warfare; D014945:Wound Healing / Q000502:physiology