Soft-tissue injury to the foot and ankle: Literature review and staged management protocol

Alexandre Leme Godoy-Santos, Tim Schepers, Soft Tissue Foot, Stefan Rammelt, Marcos Hideyo Sakaki, Cristián Ortiz Mateluna, Rafael Barban Sposeto, Panagiotis Symeonidis, Rogerio Bitar, Husam Darwish, Hans Zwipp, Ankle Group

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Complex trauma of the foot and ankle is characterized by fractures with severe soft tissue damage associated with neurovascular injury and joint involvement. These injuries are frequently present in the polytraumatized patient and are a predictor of unfavorable clinical outcome. In the initial approach to a patient with complex foot and ankle trauma, the decision between amputation and reconstruction is crucial. The various existing classification systems are of limited effectiveness and should serve as tools to assist and support a clinical decision rather than as determinants of conduct. In the emergency department, one of two treatment options must be adopted: early complete treatment or staged treatment. The former consists of definitive fixation and immediate skin coverage, using either primary closure (suturing) or flaps, and is usually reserved for less complex cases. Staged treatment is divided into initial and definitive. The objectives in the first phase are: prevention of the progression of ischemia, necrosis and infection. The principles of definitive treatment are: proximal-to-distal bone reconstruction, anatomic foot alignment, fusions in severe cartilage lesions or gross instabilities, stable internal fixation and adequate skin coverage.
Original languageEnglish
Pages (from-to)223-229
JournalActa Ortopedica Brasileira
Volume27
Issue number4
DOIs
Publication statusPublished - 1 Jan 2019
Externally publishedYes

Cite this

Godoy-Santos, A. L., Schepers, T., Foot, S. T., Rammelt, S., Sakaki, M. H., Mateluna, C. O., ... Ankle Group (2019). Soft-tissue injury to the foot and ankle: Literature review and staged management protocol. Acta Ortopedica Brasileira, 27(4), 223-229. https://doi.org/10.1590/1413-785220192704221240