*Division of Plastic Reconstructive and Maxillofacial Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD.
†Department of Surgery, The George Washington University, Washington, DC.
J Am Podiatr Med Assoc. 2023 Nov-Dec;113(6). doi: 10.7547/20-281.
Necrotizing fasciitis of the foot is a relatively rare diagnosis and has traditionally been treated with distal amputation. A 30-year-old diabetic man with Charcot-Marie-Tooth muscular atrophy developed necrotizing fasciitis of the dorsal foot and underwent surgical debridement resulting in a significant wound with exposed tendons. Serial debridements were performed, eventually followed by a staged free flap reconstruction using an anterolateral thigh fasciocutaneous flap. After allowing time for flap healing, subsequent staged equinovarus reconstruction was also performed successfully. There were no flap or postoperative complications, and the patient is progressing as expected. Flap refinement procedures have been used to enhance cosmetic and functional outcomes. This report not only showcases the success of a procedure high on the reconstructive ladder in a patient at high risk for complications but also highlights an approach in which functional recovery is also optimized successfully in a planned staged multidisciplinary manner.
足部坏死性筋膜炎的诊断较为少见，传统上采用足部远端截肢治疗。一位 30 岁的糖尿病患者，患有夏科-马里-图什病性肌萎缩，出现足部背侧坏死性筋膜炎，接受了外科清创术，导致严重的伤口暴露肌腱。进行了多次清创术，最终采用股前外侧筋膜皮瓣分期游离皮瓣重建。在等待皮瓣愈合的同时，还成功地进行了分期马蹄内翻畸形矫正术。没有出现皮瓣或术后并发症，患者恢复情况良好。皮瓣整形术已用于改善外观和功能效果。本报告不仅展示了在高风险并发症患者中实施高难度重建手术的成功案例，还强调了一种以规划分期多学科方式成功优化功能恢复的方法。
