PMC7276590_01
A photograph of the injured foot. The tarsal bones are crushed, and a part of the bone is protruding from the wound.
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F1
The tarsal bones were crushed, and a part of the bone protruded from the wound (Fig. 1).
Radiogram (a) and computed tomography image (b) of the patient's foot on arrival to our hospital. Both images show dislocation of the ankle joint and crushing of the tarsal bones.
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F2
There was no damage to important internal organs, such as the brain or heart, and his physical status was stable. The radiograph and computed tomography scan showed dislocation of the ankle joint; severe foot and ankle instability were seen (Fig. 2a and b). The mangled extremity severity score (MESS) was six and the limb salvage index (LSI) was five on arrival.
Radiogram of the foot after debridement (a). The ankle and foot are stabilized with Kirschner wires. Computed tomography image (b) showing a wide defect in the midfoot (the whitened area indicates the area of the bone defect).
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F3
After several debridement procedures, a wide bone defect had developed in the midfoot (Fig. 3a and b).
Intraoperative findings. Reproduction of the alignment of the hallux and fixation with a titanium plate (a). Kirschner wires are used to maintain the lateral arch of the foot. Reconstruction of soft tissue is performed with a latissimus dorsi flap (b).
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F4
We also fixed the lateral arch with some K-wires (Fig. 4a). Simultaneously, plastic surgeons performed soft tissue coverage with a latissimus dorsi flap (Fig. 4b).
Grafted skin flap without infection at 12 weeks after the second flap is grafted (a) radiogram of the foot after final fixation: Anteroposterior view (b) and lateral view  .
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F5
We also grafted cancellous bone chips around the other bone defect (Fig. 5a-c).
Clinical findings at 7 months postoperatively. (a) No callosities are seen in either sole.(b) The patient can walk independently without pain.
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F6
Presently, he can walk independently withoutpain, and there are no callosities in either sole (Fig. 6a and b).
Radiogram of the foot after screw removal at the time of the final follow-up: Anteroposterior view.
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F7
At the same time point, on the radiograph, bone fusion was complete and no notable complications were observed (Fig. 7).