Strategies for managing massive defects of the foot in high-energy combat injuries of the lower extremity

Blast-related lower extremity trauma presents many challenges in its management that are not frequently experienced in high-energy civilian trauma. Because many of the blasts experienced in the current conflicts are ground based, the foot and ankle have sustained considerable severity and extent of injury because of the proximity of the blast. The high functional demands required of active service members create several reconstructive challenges. The authors' experience in the current conflicts has shown a similar trend, with the magnitude of soft tissue injury usually dictating whether or not salvage may be possible. Several reconstructive options for bone defect management are outlined and discussed.