PMC10283432_01
Appearance (A) and plain radiograph (B) of the left foot on Arrival at the trauma center.
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Plain radiography revealed a proximal phalanx fracture of the big toe and 2nd to 5th metatarsal fractures (Figure 1).
Appearance (A) and plain radiograph (B) of the left foot after Emergency operation.
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Negative pressure wound therapy was performed for the skin defect (Figure 2).
Elevation of the RSAF. (A) The flap after elevation. (B) The proximal pedicle included an artery, two veins, and a nerve.
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The operation was terminated by rough suturing around the skin flap without any intervention on the vessels (Figure 3).
Clinical course throughout the 3 d after flap elevation. (A) The proximal pedicle was clamped with a vascular clip. (B) After 3 h, the flap was clearly congested. (C) Immediately after removing clips, the color tone of the flap normalized.
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Immediately after removing the clips, the color tone of the flap normalized (Figure 4).
Clinical course throughout the 5 d after flap elevation. (A) Each of the three vessels in the proximal vascular pedicle was clamped with a separate vascular clip. (B) After 6 h, the flap was clearly congested. (C) Immediately after removing the clips, the color tone of the flap normalized.
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Immediately after removing the clips, the color tone of the flap normalized (Figure 5).
Clinical course throughout the 7 d after flap elevation. (A) The remaining superficial sural vein was clamped with a vascular clip. (B) After 6 h, the flap was clearly congested.
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Immediately after removing the clip, the color tone of the flap normalized (Figure 6).
Clinical course throughout the 10 d after flap elevation. (A) The superficial sural vein was clamped with a vascular clip. (B) The flap did not become congested, even after 6 h.
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The flap did not become congested even after six hours, and clamping was continued (Figure 7).
Clinical course throughout the 12 d after flap elevation. (A) The superficial sural vein was thrombosed distal to the vascular clip. (B) The superficial sural vein was dissected and the flap transferred. (C) The color of the flap remained normal after surgery.
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The color of the flap remained normal after surgery (Figure 8).
Clinical course after flap transfer. (A) The flap survived without necrosis. (B) A full thickness skin graft was performed. (C) The soft tissue healed completely 2 months after the injury.
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Ointment treatment was continued, and the soft tissue healed completely two months after the injury (Figure 9).