INTRODUCTION

Landmine explosion results in severe composite soft tissue and bone defects especially on the heel area. Such injuries bring a formidable challenge to both patients and reconstructive surgeons. Here, we present gait analysis of the patients in one of the largest series in the literature. We discuss our experience and give important points in gait analyses of these patients. MATERIAL AND METHODS Eighty four patients who had heel defects treated with muscle flaps in Department of Plastic and Reconstructive Surgery at GMMA were examined objectively. Type of injury, localization of the wounds, tissue defects and timing of the definitive treatment were included in the study. Treatment modalities according to the severity and localization of the wounds were defined. Our preference for reconstruction of large complex defects was free muscle flaps covered by split-thickness skin grafts. Among these, we used free latissimus dorsi muscle flaps in 48 patients, and rectus abdominis muscle flaps in 36 patients. Outcomes of free muscle flap surgery were evaluated mainly by use of three dimensional gait analysis as well as dynamic podography and dynamic EMGs. The mean follow-up of these patients was 7.2 years ranging from 1 to 13 years.  The values were compared with both the results of the intact foot of the patient and with the ones obtained from 20 healthy volunteer men (control group).Statistical analysis were performed by Mann-Whitney U and Wilcoxon (non-parametric) tests.
RESULTS
Most of the patients declared their satisfaction of having their own feet instead of prosthesis. 41 patients are still working without any difficulty for a mean of 3.4 years (range, 1 to 8 years). Chronic and repetitive ulcerations (24patients, 33%) and chronic discharge through the ulcer (20 patients, 27.8%) were found. The mean time of standing or walking per day was 2.85 hours for the rest of the patients. Dynamic pressure distribution tests revealed significantly higher pressure and load values on the injured feet of the patients than the control group(p<0.05). 3-D motion analysis showed restricted range of motion(ROM) at the ankle and hip joints of the injured extremity and the difference was significant statistically(p<0.05).
CONCLUSION

In conclusion, long-term gait analyses showed that free muscle flaps offer an ideal solution for ambulation in landmine injury patients.