Soft-tissue coverage for lower-extremity trauma.

In summary, a rational approach to soft-tissue coverage in the ankle and foot should help lower osteomyelitis and bone nonunion rates and yield an excellent functional result. In addition to adequate fixation, it is crucial to first obtain a clean healthy wound by doing as many debridements as necessary. The goal should be to achieve coverage within the first week of injury to avoid the sequelae of a later closure; i.e., a potentially much higher infection rate and nonunion rate. The reconstructive options range from secondary intention, to primary closure, to skin grafts, to local flaps, to microsurgical free flaps. The choice should be dictated by the health of the patient, the existing bony and neurovascular anatomy, and the desired ultimate objective. Given the currently available orthopedic and plastic surgical techniques, it is possible to salvage almost any foot or ankle; however, we should not be carried away by our surgical armamentorium. If the salvaged extremity will take more than a year to heal, will be barely functional, and will be a constant source of pain, then a below-knee amputation should strongly be considered. The challenge in the coming decade comes both in picking the correct extremity to salvage and in applying the techniques described previously to restore it to its preinjury state.