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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

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Chih-Hung Lin Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and University, Taipei, Taiwan

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David A. Fuller Department of Orthopaedics, Cooper University Hospital, Camden, NJ

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Alissa N. Duncan Department of Podiatry, Richmond Hospital, Chardon, OH

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Liliana Camison Department of Plastic Surgery, University of Miami/Miller School of Medicine, Miami, FL

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Samir Mardini Department of Plastic Surgery, Mayo Clinic, Rochester, MN

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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)
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