Post-traumatic wounds over the dorsum of the foot - our experience

Abstract

Post-traumatic wounds over the dorsum of the foot are commonly seen in our practice. Road traffic accidents, crush injuries due to the fall of heavy objects and burns are common causes of these injures. The subcutaneous tissue in this region is very thin, and the tendons and bone are frequently exposed in these wounds. Since the skin is loosely attached to the underlying tendons, ligaments, and bones, the skin of the dorsum of the foot is also vulnerable to avulsion trauma. Added to this, there is a paucity of local tissues for coverage. Hence the management of these wounds is quite challenging. Through this article, we intend to describe our experience with traumatic dorsal foot wounds. A total of 33 patients were eligible according to the inclusion criteria and their details were included in the final analysis. There were 26 (78.79%) males and 7 (21.21%) females, with a male to female ratio of 3.71:1. The age of the study patients ranged from 8 to 62 years, with a mean age and standard deviation of 34.39 and 13.566 respectively. Majority of the study patients were in the 21-30 years age group (n=10, 30.3%). Road traffic accidents were the most common cause of traumatic dorsal foot wounds (n=20, 60.61%). Majority of the wounds showed features suggestive of infection (n=22, 66.67%) at presentation. Most of the patients in our study needed surgical intervention, in addition to medical management (n=28, 84.84%). Surgical procedures performed include split-thickness skin grafts, local flaps and free flaps. Early complications occurred in 5 (15.15%) patients and late complications in 2 (6.06%) patients. In conclusion, post-traumatic wounds of the dorsum of the foot are very common and pose a difficult reconstructive challenge. Skin grafts, local tissue flaps and free flap options are available for reconstruction; selection of the appropriate option should be individualized in a given patient. Local or distant flaps should be preferred in comparison to skin grafts, because of their long term durability and lesser chances of contractures. Reconstruction must consider form, function, and aesthetics.

Keywords: Foot; accidents; burns; crush injuries; skin transplantation; traffic.

Figure 1

Case 1. A. post chemical burn wound in a 30-year old patient. B. Defect following excision of the wound and surrounding scarred skin. C. Islanded Sural artery flap after elevation. D. Long term result after healing of the wound.

Figure 2

Case 2. A. Post-traumatic wound with exposed metatarsals in a 35-year old patient. B. Reconstruction performed with a free ALT (anterolateral thigh) flap. C. Flap in the healing phase with some residual raw areas. D. Long term result after flap has settled down.

Figure 3

Case 3. A. Post-traumatic wound with exposed bone in a 24-year old patient. B. Flap based on the first dorsal metatarsal artery perforator elevated. C. Flap healed and covered the exposed bone. D. Healed skin graft on the dorsum of the foot.