Functional outcome of wound coverage of soft tissue defects over ankle and foot

Introduction: Open fractures around the ankle and foot are complex injuries which can lead to wound complications or amputations. Based on the location, soft tissue loss is treated with different varieties of flaps. The focus has shifted to the ideal tissue for wound coverage. The aim of this study was to evaluate the functional outcome at the end of 6 months and 12 months, correlation of Mangled extremity severity score to the functional outcome and the factors that cause flap failure. Materials and Methods: Totally 32 patients (30 male, 2 female) presenting with type IIIB Gustillo-Anderson fracture over ankle and foot from October 2014 to October 2015 were followed up for a period of 12 months following open reduction, internal fixation and wound coverage with free flaps or local flaps. The mean age was 35.12 years (range: 5 years to 75 years). The patients were evaluated for Mangled extremity severity score(MESS), time period for wound coverage, failures and its cause along with foot and ankle orthopaedic society(FAOS) scores at 6 and 12 months. Results: Functional outcome following wound coverage significantly improved over 12 months which was inversely proportional to the mangled extremity severity score. On comparison of FAOS at 6 months and 12 months using Wilcoxon signed rank test for non-parametric data, p value was <0.001 which meant outcomes were significantly good for pain, symptoms, activity of daily living, sports and quality of life. However, we found no difference in outcome when comparing the same parameters with different methods of wound coverage. Venous congestion of a free flap has to be carefully monitored. Conclusion: In this study we conclude that specialized and early wound debridement, fracture reduction and soft tissue coverage (within 3 days) in the hands of an experienced surgeon gives the best functional outcome in type IIIB open fractures of ankle and foot. However, Mangled extremity severity score (MESS) is a good predictor of the outcome of the patient. The functional outcome using foot and ankle orthopaedic score has shown significant improvement from 6 months to 12 months. Selection of the flap depends on the surgeon preference and anatomical location of the wound. Patient factors like age and gender showed no difference in outcome. Early rehabilitation has a direct influence on the functional outcome of the ankle and foot movements.