Medial malleolus and deltoid ligament reconstruction in open ankle fractures with combination of vascularized fibular head osteo-tendinous flap and free flap transfers.

Treatment of the traumatic bone and soft tissue defect of the medial ankle is a challenge in reconstructive orthopedic surgery. In this report, we described a novel reconstruction procedure for the medial malleolus reconstruction using microsurgical transfer of the fibular head osteo-tendinous flap combined with a free latissimus dorsi flap (free LD flap) or a free anterolateral thigh flap (free ALT flap) in six patients. The sizes of the wounds ranged from 10 x 8 cm to 24 x 10 cm, and the sizes of the LD and ALT flaps were from 12 x 9 cm to 24 x 12 cm. All transplants survived. Five patients had primary wound healing. One patient had fibular graft and soft tissue infection that caused delayed healing. On average 4 months after surgery, all patients were able to stand and walk without crutch assistance. With a mean follow-up of 3.5 years (range, 1-5 years), all patients achieved stable ankles and were satisfied with the range of motion with excellent American Orthopedic Foot and Ankle Society functional scores (> 85). The fibular head resembles the medial malleolus in morphology. Vascularized fibular head transfer combined with a free flap provides satisfactory results for complex medial malleolus reconstruction.

Clinical study of reconstructing the medial malleolus with free grafting of fibular head composite tendon bone flap.

OBJECTIVE: To explore new surgical procedure for repairing and reconstructing medial malleolus and soft tissue defect. METHODS: According to the size of medial malleolus and composite soft tissue defect, vascular fibular head composite tendon bone flap free grafting using anterior tibial recurrent vessel as the perforating branch was designed to reconstruct the medial malleolar saddle and triangular ligament, and composite back broadest muscle flap free grafting was designed to repair the medical malleolar wound surface. From January 2000 to December 2006, the technique was used in 5 male patients who were injured by machine or in traffic accidents, causing bone and soft tissue defect. The size of wound surface ranged from 19 cm x 12 cm to 24 cm x 12 cm. RESULTS: The wound surface was healed at the first stage in 4 cases, and the other case had infection and was cured in 6 months with anti infection therapy. Postoperative follow-ups from 6 months to 6 years showed that grafted bones and free cutaneous flaps were healed well, malleolar joints were stable, joint movement was normal, and the appearance was satisfactory. The overall outcome was good. CONCLUSION: Fibular head composite tendon bone flap free grafting is effective for repairing medical malleolar defect.

[Transferring of the pedicled second metatarsal base for repairing bone defect of lateral malleolus].

OBJECTIVE: To study the method and effect of transferring the pedicled second metatarsal base for repairing bone defect of lateral malleolus. METHODS: Thirty lower limb specimens were anatomized to observe the morphology, structure and blood supply of the second metatarsal bone. Then transferring of the pedicled second metatarsal base was designed and used in 6 patients clinically. All cases were male, aged from 24 to 48 years old, and the area of bone defect was 3-4 cm. RESULTS: Followed up for 3-11 months, all patients healed primarily both in donor and recipient sites. There were excellent results in 4 cases and good results in 2 cases. The morphology and function of the malleoli were satisfactory. CONCLUSION: Transferring of the pedicled second metatarsal base for repairing bone defect of lateral malleolus is an effective and reliable operative method.