Management of traumatic degloving injury of the dorsal aspect of the midfoot and ankle: A case report

Abstract

Traumatic degloving injuries of the foot and ankle are severe, relatively rare lesions often resulting from high-energy mechanisms such as ejections in road traffic accidents. These injuries present significant challenges in both immediate management and long-term functional and aesthetic reconstruction. The involvement of severe soft tissue damage, neurovascular compromise, and potential joint involvement increases the risk of complications that can negatively impact clinical outcomes and patient quality of life. This case report details the management of a 32-year-old male who sustained extensive degloving injuries to the left foot and ankle following a motor vehicle ejection. Initial assessment revealed soft tissue damage, mediotarsal dislocation, and bone loss. Despite considering amputation due to the severity of the injury, a limb-salvage approach was chosen. Emergency surgical intervention included wound debridement, bone stabilization with Kirschner wires, and a rotational flap for soft tissue coverage. Postoperative complications included necrosis, which required negative pressure wound therapy and skin grafting. Two years after the accident, the injury site had fully healed, with the patient achieving satisfactory functional and aesthetic outcomes. The patient was able to walk independently for two kilometers with minimal discomfort and had an AOFAS Midfoot Score of 72/100. This case underscores the importance of early multidisciplinary management, careful therapeutic decision-making, and comprehensive long-term follow-up to optimize recovery in complex traumatic foot and ankle injuries.