Forefoot amputation and free flap reconstruction for fracture-dislocations of the Lisfranc joint associated with plantar soft tissue defects: A report of two cases.

UNLABELLED

Fracture-dislocations of the Lisfranc joint associated with plantar soft tissue defects are difficult to reconstruct because both the Lisfranc joint and plantar soft tissue defects must be repaired. Inadequate reduction and fixation of the Lisfranc joint causes persistent weight-bearing foot pain, and an inappropriate choice of soft tissue reconstruction for plantar weight-bearing areas causes ulcers.

CASE 1: A 48-year-old man sustained a fracture-dislocation of the Lisfranc joint. Soft tissue defects occurred in the dorsal and plantar parts beyond the forefoot, exposing the metatarsal heads. The Lisfranc joint was reduced and fixed using screws, and the dorsal and plantar soft tissue defects were covered with a free latissimus dorsi myocutaneous flap. Three years postoperatively, debulking surgery was performed, and the patient was able to walk without an orthosis and wear regular shoes, and no equinovarus deformity was observed; however, plantar ulcers occasionally occurred. Plain radiographs showed a reduced Lisfranc joint and malunited metatarsal bones.

CASE 2: A 55-year-old man sustained an open fracture-dislocation of the Lisfranc joint. Soft tissue defects occurred in the dorsal and plantar parts distal to the midfoot. After transmetatarsal amputation, the Lisfranc joint was reduced and fixed using a screw and staples, and the dorsal and plantar soft tissue defects were covered with a free latissimus dorsi myocutaneous flap. Two years postoperatively, the patient was able to walk without an orthosis and wear regular shoes, and no equinovarus deformity was observed. Plain radiographs showed a reduced Lisfranc jointFor fracture-dislocations of the Lisfranc joint associated with plantar soft tissue defects, anatomical reduction and fixation of the Lisfranc joint, free flap reconstruction of the plantar weight-bearing area, and forefoot amputation help prevent equinovarus foot deformities and preserve gait function.