Clinical case of treatment of a patient with a gunshot wound and a massive osteo-soft tissue defect of the calcaneal region

Viktoriia  Pohorila; Pavlo  Byk

doi:10.32345/USMYJ.2(163).2026.76-83

Viktoriia Pohorila Department of Surgery with a course in Hepatobiliary and Vascular Surgery, Kyiv, Ukraine https://orcid.org/0009-0009-9935-096X
Pavlo Byk Department of Surgery with a course in Hepatobiliary and Vascular Surgery, Kyiv, Ukraine https://orcid.org/0000-0002-2215-3978

DOI: https://doi.org/10.32345/USMYJ.2(163).2026.76-83

Keywords: gunshot wound, bone and soft tissue defect, calcaneal fracture, sural flap, gentamicin-loaded PMMA spacer

Abstract

Introduction. Injuries of the heel region associated with combined bone and soft-tissue defects represent a significant challenge in reconstructive surgery due to the high risk of infectious complications and loss of the limb’s weight-bearing function.

Aim. We present a clinical case of staged treatment of a military patient with a gunshot injury to the left foot, a comminuted calcaneal fracture, and a massive bone and soft-tissue defect.

Materials and Methods. During the first stage, surgical debridement of the wound, eradication of the infectious focus, and implantation of a gentamicin-loaded polymethylmethacrylate (PMMA) spacer were performed to achieve local infection control and preserve the volume of the bone defect. Following stabilization of the local wound condition, soft-tissue reconstruction was carried out using a reverse sural flap, with subsequent closure of the donor site using a split-thickness skin graft.

Results. The treatment resulted in complete coverage of the defect, preservation of flap viability, and creation of favorable conditions for subsequent bone reconstruction.

Conclusions. This case demonstrates the effectiveness of a staged reconstructive approach combining a PMMA spacer and a reverse sural flap for the management of complex traumatic heel defects and preparation of the patient for the next stage of bone defect reconstruction.

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