Soft Tissue Management of War Wounds to the Foot and Ankle

Reconstruction of the war-wounded foot and ankle is a challenging process requiring endurance, patience, diligence, and many harrowing decisions for the patient and surgeon. These decisions involve reconciling the difficult balance between expectations and feasibility. The reconstructive process does not end with the successful healing of a flap. Indeed, the surgeon must counsel the patient that flap coverage is but one small component of the reconstruction process. Multiple procedures may be necessary before the patient reaches maximum function. Overtime, the patient and the surgeon may consider revisions of a flap to improve shoe wear and weight-bearing of the reconstructed foot and ankle. Also of high importance is the availability of a skilled orthotist for custom fitting of braces and shoe wear in the post-reconstructive period. Ultimately, the patient is the final judge of the outcome of foot and ankle reconstruction. It is not a rare occurrence that the patient and surgeon agree at some point during reconstructive efforts that an amputation is the best option.