Initial Management of Severe Open Injuries and Traumatic Amputations of the Foot

Four years' experience with 410 open traumatic injuries of the foot is reported through the period of initial hospitalization and rehabilitation. Initial management principles include multiple roentgenograms; meticulous periodic assessment of vascularity and sensibility; adequate debridement; fasciotomy for minimal ischemia; delayed wound closure; bulky even-pressure dressings; elevation in functional position; internal fixation of skeletal displacement at time of wound closure; static and dynamic splinting to prevent deformity; early mobility; and stable underloaded weight-bearing. Fasciotomies must be performed whenever circulation is threatened. Traumatic amputations shorten the plantar lever arm for weight-bearing, with resultant disrupted gait. During initial management, the neutral functional position needs exaggeration into dorsiflexion to prevent secondary equinus foot deformity. Elective amputations after severe trauma should be staged to attain the most distal viable level.