ショパール関節離断術と遊離広背筋皮弁術により後足部を温存した重度足部外傷の 1 例

抄録

The patient was a 34-year-old man whose left foot was severely injured by a one-ton boiler. He was diagnosed with a Gustilo type ⅢB open fracture from the forefoot to midfoot and calcaneus fracture. We observed a degloving injury and laceration of the pedal artery at the dorsum of his left foot. We performed guillotine amputation and negative-pressure wound therapy for the amputation stump. At 22 days after initial surgery, we performed definitive reconstruction. First, we fixated the calcaneus fracture using headless compression screws. Second, we performed Chopart’s amputation, and the extensor tendons and plantar fascia were sutured together to prevent equinovarus foot. Third, we elevated a latissimus dorsi flap and covered the amputation stump. We anastomosed the thoracodorsal artery to the pedal artery and their respective accompanying veins to each other. At 28 months after injury, the patient is able to ambulate inside the house. He is also able to move around outdoors using his orthosis. We were able to avoid limb length discrepancy using a combination of Chopart’s amputation, suturing of extensor tendons and plantar fascia, and a free latissimus dorsi flap.