[Amputation vs. functional reconstruction of the hindfoot]

What is Intercalary Segmental Amputation (ISA) of the rear part of the foot (hindfoot)? We defined it as a complete or partial loss of soft tissue or skeletal (bone) part of the rear foot, with preserved vascular, soft tissue and supporting bone structures of the middle and the front (anterior) part of foot. Permanent consequence is in the sense of functional, that is, the biomechanical disorder. The most frequent reason for these injuries is stepping on antipersonnel mines (APM). The manifestation of this injury can be best seen from this radiographic presentation of the destruction of foot in ISA. When we are talking about stepping on the mine with the front or the middle part of the foot the reconstruction is usually done in order to form a solid rear support in one point. What is actually the main problem in ISA of the hindfoot. It is primarily strong contamination and destruction of soft tissue and bones; Functional problems created by disorder of the statics of entire foot and extremities; Shortened extremity with permanent possibility of compromising the soft tissue (lobe) that does not have support, and finally, and most importantly, The restriction to feasible (surgical) reconstructive procedures for rear foot. These are carried out in order to: Conserve the soft tissue and bone defects followed by reconstruction with: the usage of cortico-cancellous grafts along with treatment of soft tissue defects (the main problem being simulation of the original stepping cover of the foot as well as fixation of bone segments); and, atypical arthrodesis of foot lifting procedures along with recovery of soft tissues with subsequent compensation, and biological stimulation of fusion.

The surgical reconstruction of the rear foot in cases of severe traumatic destructions, particularly by antipersonnel land mines, results in much greater functional problems than it can be primarily evaluated: The modalities of further reconstruction (conservation) with usage of compressive-distraction methods offer much greater possibilities in terms of a sooner support possibility, the correction of the mal position fragments as well as the fusion in walking. It shortens the hospitalization period. This is the method of choice in circumstances of unrealized surgical optimum; The complete success in treatment can be achieved only in the atmosphere of good cooperation between the patient and the surgeon. It should not be forgotten that the only remaining alternative in the treatment of these severe destructions is amputation.