Forefoot amputation and free flap reconstruction for fracture-dislocations of the Lisfranc joint associated with plantar soft tissue defects: A report of two cases

Q4 Medicine

Trauma Case Reports Pub Date : 2025-04-14 DOI:10.1016/j.tcr.2025.101165

Shuya Nohmi , Ryo Wakamoto , Taro Ogawa

{"title":"Forefoot amputation and free flap reconstruction for fracture-dislocations of the Lisfranc joint associated with plantar soft tissue defects: A report of two cases","authors":"Shuya Nohmi , Ryo Wakamoto , Taro Ogawa","doi":"10.1016/j.tcr.2025.101165","DOIUrl":null,"url":null,"abstract":"<div><div>Fracture-dislocations of the Lisfranc joint associated with plantar soft tissue defects are difficult to reconstruct because both the Lisfranc joint and plantar soft tissue defects must be repaired. Inadequate reduction and fixation of the Lisfranc joint causes persistent weight-bearing foot pain, and an inappropriate choice of soft tissue reconstruction for plantar weight-bearing areas causes ulcers.</div></div><div><h3>Case 1</h3><div>A 48-year-old man sustained a fracture-dislocation of the Lisfranc joint. Soft tissue defects occurred in the dorsal and plantar parts beyond the forefoot, exposing the metatarsal heads. The Lisfranc joint was reduced and fixed using screws, and the dorsal and plantar soft tissue defects were covered with a free latissimus dorsi myocutaneous flap. Three years postoperatively, debulking surgery was performed, and the patient was able to walk without an orthosis and wear regular shoes, and no equinovarus deformity was observed; however, plantar ulcers occasionally occurred. Plain radiographs showed a reduced Lisfranc joint and malunited metatarsal bones.</div></div><div><h3>Case 2</h3><div>A 55-year-old man sustained an open fracture-dislocation of the Lisfranc joint. Soft tissue defects occurred in the dorsal and plantar parts distal to the midfoot. After transmetatarsal amputation, the Lisfranc joint was reduced and fixed using a screw and staples, and the dorsal and plantar soft tissue defects were covered with a free latissimus dorsi myocutaneous flap. Two years postoperatively, the patient was able to walk without an orthosis and wear regular shoes, and no equinovarus deformity was observed. Plain radiographs showed a reduced Lisfranc joint</div><div>For fracture-dislocations of the Lisfranc joint associated with plantar soft tissue defects, anatomical reduction and fixation of the Lisfranc joint, free flap reconstruction of the plantar weight-bearing area, and forefoot amputation help prevent equinovarus foot deformities and preserve gait function.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"57 ","pages":"Article 101165"},"PeriodicalIF":0.0000,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Trauma Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352644025000421","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Fracture-dislocations of the Lisfranc joint associated with plantar soft tissue defects are difficult to reconstruct because both the Lisfranc joint and plantar soft tissue defects must be repaired. Inadequate reduction and fixation of the Lisfranc joint causes persistent weight-bearing foot pain, and an inappropriate choice of soft tissue reconstruction for plantar weight-bearing areas causes ulcers.

Case 1

A 48-year-old man sustained a fracture-dislocation of the Lisfranc joint. Soft tissue defects occurred in the dorsal and plantar parts beyond the forefoot, exposing the metatarsal heads. The Lisfranc joint was reduced and fixed using screws, and the dorsal and plantar soft tissue defects were covered with a free latissimus dorsi myocutaneous flap. Three years postoperatively, debulking surgery was performed, and the patient was able to walk without an orthosis and wear regular shoes, and no equinovarus deformity was observed; however, plantar ulcers occasionally occurred. Plain radiographs showed a reduced Lisfranc joint and malunited metatarsal bones.

Case 2

A 55-year-old man sustained an open fracture-dislocation of the Lisfranc joint. Soft tissue defects occurred in the dorsal and plantar parts distal to the midfoot. After transmetatarsal amputation, the Lisfranc joint was reduced and fixed using a screw and staples, and the dorsal and plantar soft tissue defects were covered with a free latissimus dorsi myocutaneous flap. Two years postoperatively, the patient was able to walk without an orthosis and wear regular shoes, and no equinovarus deformity was observed. Plain radiographs showed a reduced Lisfranc joint

For fracture-dislocations of the Lisfranc joint associated with plantar soft tissue defects, anatomical reduction and fixation of the Lisfranc joint, free flap reconstruction of the plantar weight-bearing area, and forefoot amputation help prevent equinovarus foot deformities and preserve gait function.

查看原文本刊更多论文

前足截肢及游离皮瓣重建治疗伴有足底软组织缺损的Lisfranc关节骨折脱位2例报告

伴有足底软组织缺损的Lisfranc关节骨折脱位很难重建，因为Lisfranc关节和足底软组织缺损都必须修复。Lisfranc 关节复位和固定不当会导致持续性负重足痛，而足底负重区软组织重建选择不当则会导致溃疡。前足背侧和足底软组织缺损，暴露出跖骨头。使用螺钉缩小并固定了Lisfranc关节，并用游离背阔肌肌皮瓣覆盖了足背和足底软组织缺损。术后三年，患者接受了拆线手术，可以不用矫形器行走，穿普通鞋，也没有发现马蹄内翻足畸形，但偶尔会出现足底溃疡。平片显示 Lisfranc 关节缩小，跖骨错位。中足远端背侧和足底软组织缺损。经跖骨截肢后，用螺钉和订书机将 Lisfranc 关节缩小并固定，用游离背阔肌肌皮瓣覆盖足背和足底软组织缺损。术后两年，患者无需矫形器即可行走，也可以穿普通鞋，而且没有发现马蹄内翻畸形。对于伴有足底软组织缺损的Lisfranc关节骨折-脱位，解剖复位并固定Lisfranc关节，游离皮瓣重建足底负重区，以及前足截肢有助于预防马蹄内翻足畸形并保护步态功能。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Trauma Case Reports Medicine-Emergency Medicine

CiteScore

0.60

自引率

0.00%

发文量

131

审稿时长

26 weeks

期刊介绍： Trauma Case Reports is the only open access, online journal dedicated to the publication of case reports in all aspects of trauma care and accident surgery. Case reports on all aspects of trauma management, surgical procedures for all tissues, resuscitation, anaesthesia and trauma and tissue healing will be considered for publication by the international editorial team and will be subject to peer review. Bringing together these cases from an international authorship will shed light on surgical problems and help in their effective resolution.