One-Staged Simultaneous Soft Tissue and Metatarsal Reconstruction With Free Vascularized Bone Flaps for Traumatic...

Area of Science:

• Orthopedic surgery
• Trauma reconstruction
• Microsurgery

Background:

• Severe Gustilo-III foot injuries present significant reconstructive challenges due to combined bone and soft tissue defects.
• One-stage reconstruction using free fibular vascularized bone flaps (FVBF) or free iliac vascularized bone flaps (IVBF) provides immediate stability and soft tissue coverage.
• Limited contemporary outcome data necessitates further investigation into these reconstructive techniques.

Purpose of the Study:

• To evaluate the outcomes of one-stage reconstruction for severe Gustilo-III foot injuries using FVBF or IVBF.
• To analyze patient demographics, defect characteristics, perioperative variables, and functional recovery.
• To develop an evidence-based framework for managing these complex fractures.

Main Methods:

• A retrospective analysis of 6 patients with severe traumatic foot defects treated with FVBF or IVBF between 2000 and 2021.
• Assessment of defect size, surgical procedure, time to weightbearing, radiographic union, and complications.
• A systematic literature review to support the development of a reconstructive framework.

Main Results:

• All 6 patients achieved independent ambulation and returned to work after a mean follow-up of 24 months.
• Mean defect size was 8 to 22 cm, with partial weightbearing initiated at 10 weeks postoperatively.
• Complications included partial muscle/skin necrosis, osteomyelitis, and venous congestion in one patient each; no flap failures or amputations occurred.

Conclusions:

• Single-stage free FVBF/IVBF reconstruction is a viable and effective strategy for Gustilo-Anderson type III foot injuries.
• The technique demonstrates satisfactory radiographic union and a low infection rate.
• Free FVBF/IVBF reconstruction shows promise for complex foot trauma management.