Since humans evolutionally adapt to a bipedal gait, the foot is important to allow humans to stand up, walk, run, and to jump. Without the soft tissues and bones at the foot and ankle, our lower limbs could not support the weight of the body. Crush injury of the foot and ankle is a consequence of high energy trauma leading to combined bone and soft tissue loss or destruction. The treatment of crush injury of the foot and ankle remains a challenge as it is associated with high morbidity. We report two cases of traumatic injury of footand ankle to highlight the paramount importance of soft tissue coverage in limb salvaging and reconstructive surgery of foot and ankle.
The human foot serves as an important part to support
the body weight and accounts for the majority of our
movements. A mangled limb involves injury to at least
three out of four systems, namely the soft tissues, nerves,
blood supply and bone. While amputation is indicated in
some cases of mangled limb, with proper planning, limb
salvaging surgical management is also a viable option.
Special consideration to the skeletal stabilization, control
of infection, vascular status and soft tissue coverage is
paramount to the success of limb salvaging surgery. We
present a case of mangled limb which was successfully
treated with limb salvaging surgical management. Initial
debridement, Kirschner wires insertion and cross ankle
external fixation were used for skeletal stabilization. An
antibiotic spacer was inserted for local antibiotic and to
maintain the length left due to the loss of medial and
intermediate cuneiform bones. The anterior tibialis
artery and its venae comitantes were utilized for free
vascularized fibular graft to provide bony reconstruction
as well as soft tissue coverage for the mangled foot.