Limb Salvage in a Mangled Foot with Severe Midfoot Bone Loss: A Case Report and Review of Principles of Reconstruction.

INTRODUCTION: Management of a mangled foot remains one of the most challenging situations in orthopedic trauma. The decision between amputation and limb salvage is controversial, particularly in patients with severe bone and soft-tissue loss. Functional outcomes, patient expectations, vascularity, and available reconstructive expertise play important roles in decision-making. We report a successful case of limb salvage in a young female with a severely mangled foot managed using staged orthopedic and plastic surgical reconstruction.

CASE REPORT: A 26-year-old female sustained a crush injury to her right foot following a road traffic accident. Clinical examination revealed severe soft-tissue damage with extensive loss of tarsal bones and metatarsals, resulting in an unstable flail foot. The posterior tibial artery was intact and maintained distal vascularity, whereas the tibial nerve could not be identified. Emergency debridement and stabilization were performed using Kirschner wires and an external fixator. Serial wound debridement was undertaken, and a plastic surgery consultation was obtained early for soft-tissue management. Once a healthy wound bed was achieved, definitive skeletal reconstruction and soft-tissue coverage were performed simultaneously. Progressive rehabilitation was initiated postoperatively, and full weight-bearing ambulation was achieved 16 months after the final procedure. At the latest follow-up, the patient was independently ambulatory with mild residual pain and high satisfaction regarding limb preservation.

CONCLUSION: Successful limb salvage is possible even in severely mangled feet with extensive bone loss when vascularity is preserved, and multidisciplinary management is instituted early. Appropriate skeletal stabilization, repeated debridement, soft-tissue coverage, and prolonged rehabilitation are critical for achieving acceptable functional outcomes.