The Application of Posttransfer Free Flap Expansion for Management of Severe Foot Crush Injury with Extensive Soft Tissue Loss: A Case Report

Reconstruction of posttraumatic soft tissue defects has been revolutionized after the application of microvascular free flaps. However, standard flaps are limited in size and may not completely cover the defect. Flap expansion which is indicated in large defects with extensive soft tissue loss or shortage of donor tissue enables tension-free closure of large defects, minimal donor site morbidity, and better aesthetic outcomes. The literature review revealed a higher complication rate in the expansion of free flaps implanted in the extremities. A 7-year-old Palestinian girl presented with right foot crush injury and open multiple metatarsal and tarsal bone fractures with significant soft tissue loss. She underwent free latissimus dorsi flap transfer and overlying skin graft island application followed months later by expander implantation within the flap. This flap was serially expanded once a week for 4 months, until its dimension was declared to be large enough to cover the foot defect. We successfully transferred a free flap to a foot with extensive tissue loss. The overlying skin island contracted and minimized the defect size. The flap was serially expanded until completely covered the defect. No features of vascular compromise or other complications occurred; the flap remained viable with good aesthetic outcome. Posttransfer free flap expansion in lower limb defects can be utilized with meticulous care and follow-up for reconstruction of large defects.