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Necrotizing Fasciitis in Charcot-Marie-Tooth Treated with Debridement, Free Flap, and Extra-Articular Reconstruction

Joshua Yoon Division of Plastic Reconstructive and Maxillofacial Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD.
Department of Surgery, The George Washington University, Washington, DC.

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Selim Gebran Division of Plastic Reconstructive and Maxillofacial Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD.

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Arthur Nam Division of Plastic Reconstructive and Maxillofacial Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD.

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Roberto Brandao The Center for Advanced Orthopaedics, Baltimore, MD.

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Jacob Wynes Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.

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Necrotizing fasciitis of the foot is a relatively rare diagnosis and has traditionally been treated with distal amputation. A 30-year-old diabetic man with Charcot-Marie-Tooth muscular atrophy developed necrotizing fasciitis of the dorsal foot and underwent surgical debridement resulting in a significant wound with exposed tendons. Serial debridements were performed, eventually followed by a staged free flap reconstruction using an anterolateral thigh fasciocutaneous flap. After allowing time for flap healing, subsequent staged equinovarus reconstruction was also performed successfully. There were no flap or postoperative complications, and the patient is progressing as expected. Flap refinement procedures have been used to enhance cosmetic and functional outcomes. This report not only showcases the success of a procedure high on the reconstructive ladder in a patient at high risk for complications but also highlights an approach in which functional recovery is also optimized successfully in a planned staged multidisciplinary manner.

Corresponding author: Jacob Wynes, DPM, MS, Department of Orthopaedics, University of Maryland, 2200 Kernan Dr, Baltimore, MD 21207. (E-mail: jwynes@som.umaryland.edu)
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