Staged Reconstruction of the Foot After a Gunshot Through Wound with Extensive Damage to the Bone and Soft Tissues

The staged treatment of a gunshot injury to the foot (G-A III B classification) (Gustilo, Instr Course Lect 31:64–75, 1982; Gugala and Lindsey, Clin Orthop Relat Res 408:65–81, 2003) with bone and soft tissue defects is presented. At the first stage, in the hospital at the place of residence, debridement and plaster cast fixation were performed. At the second stage, on the 17th day from the injury, repeated debridement was performed with reduction of the fracture and stabilization in a ring frame. At the third stage, on the 30th day after the injury, the soft tissue defect along the plantar surface of the foot was filled with a free anterolateral femoral flap. At the fourth stage, 44 days after the injury, the dorsal defect was closed with a non-free sural flap. The device was dismantled after 106 days. As a result of the treatment, a good anatomical and functional result was obtained. A clinical example shows the possibilities of external fixation for those cases when the use of internal fixation is impossible or dangerous.