Surgical Reconstruction of a Severe Crush Injury of the Lateral Part of the Forefoot with Use of a Cross-Leg Osteocutaneous Pedicled Fibular Graft: A Case Report.

Abstract

The lateral part of the forefoot serves as part of the transverse and lateral longitudinal arches and therefore plays a key role in foot function1,2. Foot injuries resulting from high-energy trauma are increasingly common. These injuries are usually accompanied by extensive damage to the soft tissues, severely comminuted fractures or bone defects, and even injuries to the nerves and the main vessels. Limb salvage and reconstruction in these cases present great challenges for orthopaedic and plastic surgeons3. After high-energy trauma, substantial defects of the lateral part of the forefoot are commonly encountered during surgery, especially with injuries involving the four lateral metatarsal bones and the corresponding soft tissues. Limited information has been published about limb salvage surgery techniques for this region. We describe a case of a severe crush injury of the four lateral metatarsal bones with corresponding soft-tissue damage that was treated effectively with a cross-leg osteocutaneous pedicled fibular graft. The patient and his family were informed that data concerning the case would be submitted for publication, and they provided consent. A twenty-four-year-old man was admitted to the hospital and treated for injuries to the left lower extremity, which had been sustained in a motorcycle crash. Initial examination revealed extensive soft-tissue injury of the left foot associated with a Gustilo-Anderson type-IIIC comminuted fracture of the metatarsal bones (Fig. 1-A). The metatarsal bone fractures were fixed with Kirschner wire, and the wound was covered with a vacuum-assisted closure device during emergency treatment. Necrosis of the four lateral metatarsal bones was considered to …