[Reconstruction of tarsus and metatarsus with free iliac flap--a case report and review of literature]

Abstract

Procedure and late results of treatment of 17 year old female with severe trauma of right foot by agricultural machine are presented. Defects included soft tissues of the dorsal foot, II-IV metatarsal bones, cuneiform bones and majority of the navicular bone. The patient was first treated in a regional hospital and due to infection an amputation of the lower extremity distal part was considered. In our department an emergency necrectomy was carried out, general and local antibiotics were administered and the wounds were split skin grafted. Complete one stage reconstruction of the soft tissues and bones with free osteocutaneous iliac flap was performed three months later. Deep circumflex iliac vessels were anastomosed end-to-side to the only uninterrupted posterior tibial vessels. Two axial K-wires were used to stabilize vascularized bone graft. A fragment of the ilium 8.5 x 6.0 x 1.5 centimeters of favourable arcuate shape was used to reconstruct longitudinal and transversal arches of the foot. The vascularized bone graft healed three months after the reconstruction. The patient recovered full weight bearing capability after a year. No complications were observed in the donor site in spite of the fact that the patient was pregnant and had a normal uncomplicated delivery.