Soft tissue coverage options for ankle wounds

Soft tissue deficiencies of the ankle are caused by several mechanisms, such as trauma, tumor, and infection. Compounding the reconstructive problems is that soft tissue problems often present in patients who have underlying diseases such as peripheral vascular disease, diabetes or both. For example, a 65-year-old person with diabetes who smokes two packs of cigarettes per day sustains an ankle fracture. After undergoing open reduction and internal fixation of the fracture, there is subsequent wound behiscence over the patient's fibular plate. The wound edges cannot be reapproximated, and there is loss of soft tissue. What should treatment be for this soft tissue problem? Another example is a 45-year-old rheumatoid patient who takes 20 mg of steroids a day and undergoes posterior tibial tendon repair after rupture. One month after surgery, the surgical wound dehisces, resulting in exposure of the tendon repair. What is the approach for adequate and effective soft tissue treatment? The purpose of this article is to address such complex problems and to provide an algorithm for soft tissue reconstruction of the ankle.