• 1.

    Shereff, MJ . :Fractures of the forefoot. .Instr Course Lect 39::133. ,1990. .

  • 2.

    Taylor, GI, GD Miller, and FJ Ham. :The free vascularized bone graft. A clinical extension of microvascular techniques. .Plast Reconstr Surg .55::533. ,1975. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Yajima, H, S Tamai, Y Kobata, et al. :Vascularized composite tissue transfers for open fractures with massive soft tissue defects in the lower extremities. .Microsurgery 22::114. ,2002. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Yazar, S, CH Lin, and FC Wei. :One stage reconstruction of composite bone and soft tissue defects in traumatic lower extremities. .Plast Reconstr Surg 114::1457. ,2004. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Celikoz, B, M Sengezer, S Isik, et al. :Subacute reconstruction of lower leg and foot defects due to high velocity-high energy injuries caused by gunshots, missiles, and land mines. .Microsurgery 25::3. ,2005. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Pelissier, P, P Boireau, D Martin, et al. :Bone reconstruction of the lower extremity: complications and outcomes. .Plast Reconstr Surg 111::2223. ,2003. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Isik, S, B Celikoz, M Demirogullan, et al. :Repair of high-energy-induced tissue defects of the dorsal foot by free muscle transfer and skin graft. .Ann Plastic Surg 43::21. ,1999. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Weinberg, A, R Mosheiff, M Liebergall, et al. :Amputated lower limbs as a bank of organs for other organ salvage. .Injury 30 ( suppl 2:):B34. ,1999. .

  • 9.

    Ramseier, LE, HA Jacob, and GU Exner. :Foot function after ray resection for malignant tumors of the phalanges and metarsals. .Foot Ankle Int 25::53. ,2004. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Toma, CD, M Dominkus, M Pfeiffer, et al. :Metatarsal reconstruction with use of free vascularized osteomyocutaneous fibular grafts following resection of malignant tumors of the midfoot: a series of six cases. .J Bone Joint Surg Am 89::1553. ,2007. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Exner, GU, HA Jacob, and J Middendorp. :Reconstruction of the first and second metatarsals with free microvascular fibular bone graft after resection of a Ewing sarcoma. .J Pediatr Orthop B 7::239. ,1998. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Toriyama, K, Y Kamei, S Yagi, et al. :Reconstruction of the first and second metatarsals with free vascularised double-barrelled fibular graft after resection of a chondrosarcoma. .J Plast Reconstr Aesthet Surg 62::e580. ,2009. .

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation

Foot Salvage After Loss of the First and Second Metatarsal Rays with a Free Fibular Osteocutaneous Flap

Christopher J. Salgado Department of Plastic Surgery, University of Miami/Miller School of Medicine, Miami, FL

Search for other papers by Christopher J. Salgado in
Current site
Google Scholar
PubMed
Close
 MD
,
Chih-Hung Lin Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and University, Taipei, Taiwan

Search for other papers by Chih-Hung Lin in
Current site
Google Scholar
PubMed
Close
 MD
,
David A. Fuller Department of Orthopaedics, Cooper University Hospital, Camden, NJ

Search for other papers by David A. Fuller in
Current site
Google Scholar
PubMed
Close
 MD
,
Alissa N. Duncan Department of Podiatry, Richmond Hospital, Chardon, OH

Search for other papers by Alissa N. Duncan in
Current site
Google Scholar
PubMed
Close
 DPM
,
Liliana Camison Department of Plastic Surgery, University of Miami/Miller School of Medicine, Miami, FL

Search for other papers by Liliana Camison in
Current site
Google Scholar
PubMed
Close
 BS
, and
Samir Mardini Department of Plastic Surgery, Mayo Clinic, Rochester, MN

Search for other papers by Samir Mardini in
Current site
Google Scholar
PubMed
Close
 MD

Severely comminuted fractures of the metatarsal bones with significant bone and soft-tissue loss have commonly subjected patients to proximal amputation procedures. We describe two patients who experienced high-energy traumatic injuries to their limbs that resulted in significant destruction of their first and second metatarsal bones with overlying soft-tissue trauma not amenable to local coverage. In both cases, a vascularized free fibular osteocutaneous flap was used to reconstruct the metatarsal bone defect and traumatized soft tissues so that a proximal amputation was avoided. At an average of 14 months of follow-up, both patients had recovered well and regained independent ambulation, with one patient being able to play soccer. We show that the free fibular osteoseptocutaneous flap is useful in reconstructing significant metatarsal bone defects and in avoiding amputations in this patient population. The skin component of the flap may be used to fill soft-tissue losses, and the fibula bone may be osteotomized so that more than one ray may be reconstructed. (J Am Podiatr Med Assoc 101(6): 531–536, 2011)

Corresponding author: Christopher J. Salgado, MD, Plastic Surgery, University of Miami/Miller School of Medicine, 1120 NW 14th Street, 4th Floor. Miami, FL 33136. (E-mail: salgado_plastics@hotmail.com)