Soft-tissue reconstruction of the foot and ankle

Successful reconstruction of the severely injured foot and ankle remains a challenge for the surgeon. Frequently, bone and joint injuries to this area with overlying soft-tissue injuries or losses require the coordinate management by orthopedic and reconstructive specialists. Healthy, well-functioning feet are necessary to perform daily activities. Because of the dense packaging of the specialized interdependent structures of the feet, injuries to this area commonly cause significant (composite) wounds that, if not properly managed, can lead to progressive deformity and disability. Basic principles of wound management, especially those pertaining to open fracture management--wound evaluation, debridement, fracture reduction and fixation, preservation of viable tissues, prevention of infection, early soft-tissue reconstruction, and early bony reconstruction--are applicable in the management of foot and ankle wounds. The unique anatomy of the foot complicates reconstruction by limiting the availability of local tissues. Further reconstructive difficulties arise from the functional demands placed on feet and from the distal relationship of the feet to the rest of the body. Successful reconstruction of the foot is predicated on an intimate knowledge of the unique anatomy of the region, of the functional demands required of the feet, and of reconstructive methods. The simplest appropriate technique for the injured foot that is likely to produce the best outcome should be selected. Reconstructive options from the most simple to the complex include primary closure, healing by secondary intention, grafting, flaps (local and distant), and amputation. As typified by the authors' experience, reconstruction of the soft tissues of the foot and ankle frequently requires more complex methods. Seventy percent of our patients have required free-tissue transfer reconstructions, and an additional 5% have undergone other flap reconstructions.