Abstract

CASTRO, João Nunes; RAMIRO, Nuno  and  REIS, José. Traumatismo de alta energia do pé com perda de substância óssea: Reconstrução passo-a-passo. Rev. Port. Ortop. Traum. [online]. 2017, vol.25, n.4, pp.320-330. ISSN 1646-2122.

Objective: A mangled foot is a challenge in orthopedic surgery. The decision between amputation and attempted reconstruction remains, to this day, based on a case-by-case decision. Description: We present a patient, male, 14 years old, victim of a propeller accident of a boat and consequent open  fracture IIIB Gustillo and Anderson (GA) of the left ankle and foot. The extremity was evaluated with the "Mangled Extremity Severity Index" (MESS) and a value of 6 was obtained. During the debridement and stabilization with external fixator an extensive bone necrosis of the midfoot was verified and so a sequential treatment was defined: external fixation revision, debridement with removal of the necrotic bone and coverage of soft tissue  with musculo-cutaneous graft. The final reconstruction involved the use of stabilized iliac graft with plate and screws. At 1st year follow-up the limb function was satisfactory, with a score of 82 on the American Foot and Ankle Score (AOFAS) and 82.5 on the Foot and Ankle Disability Index (FADI). Comments: In the literature there is a considerable amount of therapeutic options. The paucity of scientific evidence supports the controversy between the benefit of a full early treatment versus a sequential reconstruction treatment. In this way, the treatment of a mangle foot with bone loss should be based on an adequate and individualized clinical evaluation. The assessment of mutilated extremities with salvage scores  such as MESS, are useful but are not in themselves sufficient for determining the viability or amputation of the limb.

Keywords : Mangled foot; bone loss; open fracture; autologos graft; osteossynthesis.

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