title: Foot salvage after loss of the first and second metatarsal rays with a free fibular osteocutaneous flap.
abstract: Severely comminuted fractures of the metatarsal bones with significant bone and soft-tissue loss have commonly subjected patients to proximal amputation procedures. We describe two patients who experienced high-energy traumatic injuries to their limbs that resulted in significant destruction of their first and second metatarsal bones with overlying soft-tissue trauma not amenable to local coverage. In both cases, a vascularized free fibular osteocutaneous flap was used to reconstruct the metatarsal bone defect and traumatized soft tissues so that a proximal amputation was avoided. At an average of 14 months of follow-up, both patients had recovered well and regained independent ambulation, with one patient being able to play soccer. We show that the free fibular osteoseptocutaneous flap is useful in reconstructing significant metatarsal bone defects and in avoiding amputations in this patient population. The skin component of the flap may be used to fill soft-tissue losses, and the fibula bone may be osteotomized so that more than one ray may be reconstructed.
authors: Department of Plastic Surgery, University of Miami/Miller School of Medicine, FL, USA. salgado_plastics@hotmail.com
authors: Christopher J
authors: CJ
authors: Salgado
authors: Chih-Hung
authors: CH
authors: Lin
authors: David A
authors: DA
authors: Fuller
authors: Alissa N
authors: AN
authors: Duncan
authors: Liliana
authors: L
authors: Camison
authors: Samir
authors: S
authors: Mardini
mesh_terms: D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005360:Fibula / Q000637:transplantation*; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery; D058752:Free Tissue Flaps; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods; D016038:Skin Transplantation / Q000379:methods*; D055815:Young Adult