PDF(Pubmed)
Abstract：
In severe foot trauma, it is difficult to determine the level of amputation when the crush injury is severe. We report a case of amputation near Lisfranc that achieved forefoot amputation-like results by using bone and soft tissue reconstruction while considering tendon balance. The patient was a 40-year-old male. The patient\'s left leg was caught in a garbage truck and sustained a crush injury. The second to fifth metatarsals were amputated at the diaphysis, and a high degree of instability of the Lisfranc joint was observed. A high degree of contamination was detected in the patient\'s wound, and the second to fifth toes were amputated at the Lisfranc joint during the initial treatment. The ends of the tibialis anterior, tibialis posterior and peroneus longus were preserved. On day 5 in the hospital, Lisfranc joint fixation of the hallux, amputation of the first metatarsal and reconstruction of the peroneus brevis were performed. On day 13, extensor hallucis longus tendon transfer and free anterolateral thigh flap were performed. On day 80, the patient was able to walk in regular shoes or non-orthopedic shoes. One year after reconstructive surgery, the patient had an average SAFE-Q score of 86.2 and mild varus deformity of the foot remained. In cases of severe foot trauma, the aim of reconstruction should be partial forefoot amputation whenever possible.
摘要：
在严重的足部创伤中，当挤压伤严重时，很难确定截肢的程度。我们报告了在Lisfranc附近截肢的案例，该案例通过使用骨骼和软组织重建同时考虑肌腱平衡，实现了前足截肢样结果。患者是一名40岁的男性。病人的左腿被一辆垃圾车抓住，受到挤压伤。第二至第五meta骨在骨干处被截肢，观察到Lisfranc关节高度不稳定。在病人的伤口中检测到高度污染，在初始治疗期间，第二至第五脚趾在Lisfranc关节处被截肢。胫骨前肌的末端，保留了胫骨后肌和腓骨长。在医院的第五天，Lisfranc联合固定术，进行了第一meta骨的截肢和腓骨短肢的重建。第13天，进行长伸肌肌腱转移和游离股前外侧皮瓣。在第80天，患者能够穿着普通鞋或非矫形鞋行走。重建手术一年后,患者的平均SAFE-Q评分为86.2分,足内翻畸形仍有轻度.在严重的足部创伤的情况下，重建的目的应该是尽可能部分前足截肢。
