Saving of Foot Support Ability in Post-traumatic Defects Using Microsurgical Tissue Autotransplantation

Background. Severe open injuries of the lower extremities in most cases are the result of high-energy trauma, because the foot and ankle are damaged as a result of automobile accidents almost in every fourth victim. According to the literature, the percentage of infectious complications after surgical debridement of open injuries of the foot is 43–67.9% and shows no tendency to decrease.

Material and methods. We performed 32 operations with the use of free revascularized grafts in patients aged from 16 to 70 years with extensive posttraumatic defects of the foot between 2010 and 2018.

Results. As a result, 30 (93.7%) out of 32 grafts provided foot support ability provided during the post-operative period. When replacing large defects (more than 80 cm²) of soft tissues supporting surface of the foot we used free musculocutaneous flap of the latissimus dorsi, fasciocutaneous flaps were used for defects of the dorsum of the foot (less than 80 cm²). Long-term results were assessed using the Foot and ankle ability Measure (FAAM) questionnaire.

Conclusion. Primary early replacement of tissue defects on the foot with free revascularized autografts is the method of choice for solving this problem, as it allows you to maintain the supporting function of the foot and is often alternative method to amputation.

1. Koryshkov NA. Travma stopy. Yaroslavl’; Rybinsk: Rybinskiy dom pechati Publ.; 2006. (In Russ.)

2. Rodomanova, LA. Vozmozhnosti rekonstruktivnoy mikrokhirurgii v rannem lechenii bol’nykh s obshirnymi posttravmaticheskimi defektami konechnostey: cand. med. sci. diss. synopsis. Saint Peterburg; 2010. (In Russ.)

3. Shibaev EY, Ivanov PA, Vlasov AP, Kisel DA, Lasarev MP, Nevedrov AV, Tsoglin LL. Soft Tissue Reconstruction in Patients With Severe Open Tibia Fractures. Russian Sklifosovsky Journal Emergency Medical Care. 2014;(1):30–36. (In Russ.)

4. Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. A prospective evaluation of the clinical utility of the lowerextremity injury-severity scores. J Bone Joint Surg Am. 2001;83(1):3–14. PMID: 11205855 https://doi.org/10.2106/00004623-200101000-00002

5. Moroz VYu, Yudenich AA, Mikhaylov IA, Kafarof TG, Guntsevich GI. Mikrokhirurgicheskoe ustranenie defektov myagkikh tkaney stopy svobodnymi vaskulyarizirovannymi loskutami. Pirogov Russian Journal of Surgery. 1997;(7):40–43. (In Russ.)

6. Cherkes-Zade DI, Kamenev YuF. Khirurgiya stopy. Moscow: Meditsina Publ.; 2002. (In Russ.)

7. Lee KJ, Lee SH, Kim MB, Lee YH. Adipofascial fold-down flaps based on the posterior tibial artery perforator to cover the medial foot and ankle defects. J Plast Reconstr Aesthet Surg. 2016;69(12):e229-e237. PMID: 27693021 https://doi.org/10.1016/j.bjps.2016.08.019

8. Hertel R, Strebel N, Ganz R. Amputation versus reconstruction in traumatic defects of the leg: outcome and costs. J Orthop Trauma. 1996;10(4):223–229. PMID: 8723399

9. Khouri R, Shaw WW. Reconstruction of the lower extremity with microvascular free flaps: a 10-year experience with 304 consecutive cases. J Trauma. 1989;29(8):1086–1094. PMID: 2668545 https://doi.org/10.1097/00005373-198908000-00005

10. Koryshkov NA. Lechenie povrezhdeniy perednego otdela stopy s uchetom sostoyaniya regionarnoy gemodinamiki: cand. med. sci. diss. synopsis. Moscow;1985. (In Russ.)

11. Simon RR., Koenigsknecht SJ. Emergency Orthopedics. Norwalk Conn.: Appleton & Lange, 1995. (Russ. ed.: Simon RR, Kenigsknekht SDzh.. Neotlozhnaya ortopediya konechnosti: per. s angl. Mosсow: Meditsina publ.; 1998)

12. Bondurant FJ, Cotler HB, Buckle R, Miller-Crotchett P, Browner BD. The medical and economic impact of severely injured lower extremities. J Trauma. 1988;28(8):1270–1273. PMID: 3137367 https://doi.org/10.1097/00005373-198808000-00023

13. Antokhiy NI. Mikrokhirurgicheskaya autotransplantatsiya sostavnykh loskutov v plastike defektov myagkikh tkaney: cand. med. sci. diss. synopsis. Moscow; 1987. (In Russ.)

14. Amiroslanov YuA, Mitish VA, Borisov IV, Lipatov KV. Rannie rekonstruktivno-vosstanovitel’nye operatsii pri obshirnykh travmaticheskikh povrezhdeniyakh goleni, oslozhnennykh gnoynoy infektsiey. Pirogov Russian Journal of Surgery. 1998;(5):36–39. (In Russ.)

15. Borzykh AV, Trufanov IM, Pogorilyak AI, Rushay AK. Reabilitatsiya postradavshikh s travmaticheskim osteomielitom. Palliative Medicine and Rehabilitation. 1998;(2–3):134. (In Russ.)

16. Mel’nikov AG. Lechenie perelomov kostey perednego otdela stopy u voennosluzhashchikh: cand. med. sci. diss. synopsis. Moscow; 1974. (In Russ.)

17. Tajsic N, Winkel R, Husum H. Distally based perforator flaps for reconstruction of post-traumatic defects of the lower leg and foot. A review of the anatomy and clinical outcomes. Injury. 2014; 45(3):469–477. PMID: 24075220 https://doi.org/10.1016/j.injury.2013.09.003

18. Padberg FT Jr, Rubelowsky JJ, Hernandez-Maldonado JJ, Milazzo V, Swan KG, Lee BC, et al. Infrapopliteal arterial injury: prompt revascularization affords optimal limb salvage. J Vasc Surg. 1992;16(6):877–886. PMID: 1460714