Clinical case of reconstruction of gunshot foot injury using the alt free flap technique

Abstract

With the onset of the full-scale war in Ukraine, the number of wounded individuals with soft tissue defects has significantly increased, necessitating the use of plastic surgery techniques for wound closure. However, to date, this surgical treatment method has not been widely adopted in military medicine due to the limited number of qualified specialists, the technical complexity of such procedures, and the need for specialized surgical department resources. Objective. To explore alternative surgical treatment approaches for patients with extensive foot defects using a free anterolateral thigh (ALT) flap to improve the functional, aesthetic, and weight-bearing properties of the foot. Methods. A single-stage reconstructive plastic surgery using a free composite flap (ALT free flap) was performed on a 49-year-old male serviceman due to the long-term consequences of a mineblast injury. The injury resulted in a chronic combined nonhealing granulating wound on the plantar surface of the right foot, comprising 60 % hypertrophic keloid scar tissue and 40 % non-healing granulating wound. To restore the anatomical integrity of the affected soft tissue, a free anterolateral perforator thigh flap (Anterolateral thigh flap) was used. Results. The transferred ALT flap successfully integrated into the plantar surface of the foot without complications. In the early postoperative period, venous congestion and epidermolysis were observed. This clinical case demonstrates that reconstructive plastic surgery using an ALT flap is an optimal approach for restoring the function of the damaged foot. Conclusions. The use of a free ALT flap addresses the issue of insufficient local donor site availability for volumetric, aesthetic, and functional reconstruction. Additionally, it enables microsurgical anastomosis at a favorable distance from the compromised area with impaired tissue trophism, which helps reduce technical difficulties and the rate of postoperative complications.