PMC3385378_01
Medial side of foot showing granulating wound 11 cm x 9 cm with a bony tunnel communicating with the wound on the lateral side of the foot
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F1
When the patient presented to us, he had granulating wound on the dorsum of left foot, measuring 11 cm x 9 cm on the medial side and 7 cm x 5 cm on the lateral aspect, with a bony tunnel through the cuneiform communicating both these wounds [Figures 1 and 2].
A granulating wound, 7 cm x 5 cm on the lateral aspect, with a bony tunnel connecting the wound on the medial side
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F2
When the patient presented to us, he had granulating wound on the dorsum of left foot, measuring 11 cm x 9 cm on the medial side and 7 cm x 5 cm on the lateral aspect, with a bony tunnel through the cuneiform communicating both these wounds [Figures 1 and 2].
X-ray showing the bony tunnel through the tarsal bones
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F3
Lateral X-ray showed a tunnel through the tarsals [Figure 3].
Gracilis conserving mini-gracilis flap based on the minor pedicle. Showing the preservation of continuity of the muscle (approximately 50% width at the site of harvest)
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F4
We harvested a small cylindrical segment of gracilis, measuring 5 cm in length and 2.5 cm in breadth, based on its minor pedicle, preserving the continuity of the muscle [Figures 4 and 5].
Schematic mini-gracilis raised on minor pedicle, showing conservation of the major neurovascular pedicle and major bulk and continuity of muscle
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F5
We harvested a small cylindrical segment of gracilis, measuring 5 cm in length and 2.5 cm in breadth, based on its minor pedicle, preserving the continuity of the muscle [Figures 4 and 5].
Complex wound converted to simple wound after filling the bony tunnel with mini-gracilis free tissue transfer
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F6
Thus, the complex defect was converted into two simple wounds with granulating wound in the periphery and vascularised muscle in the centre, which was skin grafted [Figure 6].
Well-settled skin graft on dorsolateral side with noticeable muscle bulge at the site of bony tunnel
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F7
The patient has a well-settled skin graft on the foot and a well-settled small donor scar in the right thigh [Figures 7 and 8].
Well-settled skin graft on the medial side with noticeable muscle bulge at the site of bony tunnel
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F8
The patient has a well-settled skin graft on the foot and a well-settled small donor scar in the right thigh [Figures 7 and 8].