Abstract / Summary
Complex metatarsal defects, particularly those accompanied by soft-tissue loss, are difficult to reconstruct because both skeletal continuity and durable wound coverage must be restored. Existing evidence is largely limited to isolated case reports and small series with short follow-up. We retrospectively reviewed 12 patients who underwent metatarsal reconstruction between January 2010 and January 2025. Eleven patients had traumatic defects with associated soft-tissue loss, and one underwent reconstruction after enchondroma resection. Six patients had isolated first-metatarsal defects, four had two-metatarsal defects, and two had multi-metatarsal defects. Seven patients received vascularized fibular flaps and five received vascularized iliac flaps. The mean length of the transferred bone segments was 6.0 cm (range, 3.0–11.0 cm): 6.4 cm for fibular bone flaps and 5.3 cm for iliac bone flaps. Soft-tissue reconstruction was individualized according to defect characteristics. All transferred bone flaps achieved initial radiographic union without graft necrosis, bone resorption, or osteomyelitis; one pediatric patient later developed growth-related first-ray shortening with stress fracture and pseudarthrosis. All skin flaps ultimately survived; one patient developed partial distal flap necrosis that healed with dressing changes. No donor-site functional impairment or sensory disturbance was observed. During a mean follow-up of 5.7 years, marked graft remodeling was observed in patients followed for more than 2 years. The mean final American Orthopaedic Foot & Ankle Society score was 83.7. Vascularized fibular and iliac bone flaps, combined with appropriate soft-tissue coverage, provide a feasible approach for complex metatarsal defects and can achieve durable structural and functional outcomes.