Reconstruction of complex foot injury using anterior thigh free flap with vastus lateralis muscle pedicle and tri-cortical Iliac crest bone graft: a case report

Introduction and Importance: Complex foot injuries from high-velocity trauma pose significant challenges due to combined bony and soft tissue damage. Early and comprehensive reconstruction using an orthoplastic approach is critical for limb salvage and achieving functional recovery. Presentation of Case: A 22-year-old male sustained a severe crush injury to the right foot following a motor vehicle accident. The injury included degloving, extensive soft tissue loss, and multiple fractures: a comminuted first metatarsal shaft fracture, a medial cuneiform bone defect, and minimally displaced fourth and fifth metatarsal fractures. Initial management included wound debridement, K-wire stabilization, and infection control. Due to dorsal skin necrosis and non-viability of the fifth toe, additional debridement and fifth ray resection were performed. A free anterolateral thigh flap with vastus lateralis muscle pedicle was used for soft tissue reconstruction. Later, a tricortical iliac crest bone graft was applied to reconstruct the medial arch and secured with titanium mini-plates and screws. Clinical Discussion: The coordinated orthoplastic approach allowed for early soft tissue coverage and delayed bony reconstruction, which are essential for functional recovery in complex foot trauma. The use of a chimeric myofasciocutaneous flap provided durable soft tissue coverage and structural support. Close multidisciplinary collaboration with Orthopaedic and Plastic Surgery team for surgical management and in-hospital management with physician, dietician and physiotherapist was vital for managing complications and optimizing outcomes. Conclusion: This case demonstrates that a multidisciplinary orthoplastic strategy with timely soft tissue and bony reconstruction can result in successful limb salvage and functional recovery in complex foot trauma. Long-term follow-up remains crucial to address any post-traumatic complications.