TY - JOUR
T1 - Soft-tissue injury to the foot and ankle: Literature review and staged management protocol
AU - Godoy-Santos, Alexandre Leme
AU - Schepers, Tim
AU - Foot, Soft Tissue
AU - Rammelt, Stefan
AU - Sakaki, Marcos Hideyo
AU - Mateluna, Cristián Ortiz
AU - Sposeto, Rafael Barban
AU - Symeonidis, Panagiotis
AU - Bitar, Rogerio
AU - Darwish, Husam
AU - Zwipp, Hans
AU - Ankle Group
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85070721667&origin=inward
U2 - 10.1590/1413-785220192704221240
DO - 10.1590/1413-785220192704221240
M3 - Review article
C2 - 32788854
VL - 27
SP - 223
EP - 229
JO - Acta Ortopedica Brasileira
JF - Acta Ortopedica Brasileira
SN - 1413-7852
IS - 4
ER -