Functional and contour restoration in severely injured extremities - our approach to reconstruct composite (Multizonal) injuries of foot and ankle

Background

Coverage of ankle and foot defects has been challenging. This study highlights the importance of microsurgical free tissue transfer as an opportunity for a surgeon to deal with composite foot defects with variable etiology.

Method

A retrospective case review of 28 patients with large Multizonal foot defects resulting from trauma and tumor resections presented to tertiary care hospitals from 2008-to 2021. All defects were reconstructed by free flaps. 14 patients had ALT flaps, 4 underwent free fibula flaps, and 6 had LD flaps and 4 Rectus Abdominis free flaps. Different modalities have been reviewed by literature for the type of flap used, zone involvement, and age groups.

Result

26 patients were male and 2 females. Most of our patients were adults presenting post-trauma including n ​= ​21 (75%) road traffic accidents n ​= ​17 (60.7%), mine blast injury n ​= ​4 (14.2%), and malignancy in n ​= ​3 (10.7%). Age range was from 5 years to 75 years. Most of the patients had involvement of subunits 3 and 4 followed by a combination with other sub-units. After free microsurgical tissue transfer, 2 patients needed immediate exploration, one had arterial compromise and one had venous insufficiency. All flaps survived. 3 patients underwent flap debulking in the follow-up period. All patients were followed for 2 years and returned to daily activities and near to normal ambulation.

Conclusion

Microsurgical free tissue transfer has not only proven its role in post-traumatic composite foot defects but also in malignancies where resection with free margins followed by foot reconstruction poses a major challenge.