Ankle Arthrodesis with Free Vascularized Fibula Autograft Using Saphenous Vein Grafts: A Case Series

Plastic and Reconstructive Surgery
Paulo P PiccoloL Scott Levin

Abstract

In select high-risk cases of ankle arthrodesis, conventional techniques may lead to a high incidence of failure because of a combination of multiple operations; high risk of infection; avascular, often bulky allografts; and poor soft-tissue quality. In high-risk distal limb salvage, the authors have performed ankle arthrodesis using a free vascularized fibula graft from the ipsilateral limb with saphenous vein grafts. The authors present data from six patients. The cause of the defect was avascular necrosis of the talus (n = 4), osteomyelitis (n = 1), and failed total ankle replacement (n = 1). The ipsilateral fibula was used in all cases as a free vascularized graft. Nonviable bone and soft tissue were débrided, and the fibula was shortened to size and impacted into the cavitary space spanning the distance between the tibia, talus, and calcaneus. The pedicle distally was anastomosed to saphenous vein grafts and proximally anastomosed to the divided peroneal vessels. The flap success rate was 83 percent (n = 5). The complication rate was 83 percent; complications included flap loss (intraoperative arterial thrombosis), loss of skin island, hematoma, and arterial thrombosis. Despite one flap failure and a high complication rate,...Continue Reading

References

Feb 11, 2004·Foot & Ankle International·Hiroshi YajimaYoshinori Takakura
Dec 12, 2007·Operative Orthopädie und Traumatologie·Stephan Schill
May 21, 2010·Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons·Pieter BullensJan Willem Louwerens
Jun 26, 2012·The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons·Janson HolmJared Remmers
May 17, 2013·Plastic and Reconstructive Surgery·Nicholas T HaddockL Scott Levin
May 6, 2014·The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons·Jochen PaulVictor Valderrabano
Jan 27, 2016·The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons·Thomas S Roukis, Rachel B Kang
Feb 6, 2016·Journal of Reconstructive Microsurgery·Jussi Petteri RepoErkki Tukiainen

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Citations

Mar 26, 2019·Plastic and Reconstructive Surgery·Alberto Pérez-GarcíaEduardo Simón-Sanz
Nov 3, 2020·The Bone & Joint Journal·Andrea SambriMassimiliano De Paolis
Mar 7, 2021·Clinics in Plastic Surgery·Zvi SteinbergerL Scott Levin
Nov 11, 2021·Foot & Ankle International·Hanci ZhangJames Nunley

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