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Enhancing Ankle Arthrodesis in Complex Cases: The Role of Vascularized Fibula Flaps
Paneed Jalili
*3, Christopher Miller
2, A. Samandar Dowlatshahi
11Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 2Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 3Chicago Medical School, Rosalind Franklin University, North Chicago, IL
Background:
The vascularized fibula flap, known for its dependable blood supply, alongside its straightforward harvest, delivers vascular support, expediting healing and preserving osteocytes. Evidence suggests that integrating fibula flaps into ankle arthrodesis cases may enhance outcomes, including reduced infection, expedited recovery, and diminished nonunion rates. The objective of this case series is to present the use of pedicled and free fibula flaps in complex ankle reconstructions.
Methods:
This retrospective case series presents all patients 18 and older that underwent fibula flap reconstruction in conjunction with ankle arthrodesis between January 1, 2019, and June 1, 2023, at a single institution. Patients were identified through the operating room (OR) schedule, and their data was collected from medical charts stored in the institution's online medical records (OMR).
Results:
Four males (average age 65.6, range: 53-71 years) underwent ankle arthrodesis with fibula flap. Their prior history included nonunion and infection, requiring on average 6.25 (range: 4-10) interventions prior to arthrodesis with fibula flap. One patient experienced a post-flap infection, treated successfully with hardware removal. PROMIS physical function scale showed improvement in two patients (pre-flap average: 23.14, post-flap: 41.23), with decreased pain interference (pre-flap: 64.47, post-flap: 56.08). One patient lacked pre-flap PROMIS scores but achieved post-flap scores of 43.52+/-1.92 (physical function) and 50.12+/-2.37 (pain interference). Average hospital stay was 7 days (range: 6-8). All patients underwent union.
Conclusion: This case series demonstrates our positive experience with the fibula flap for complex ankle arthrodesis cases, highlighting its role in achieving union, reducing infection, improving functionality, and ultimately enhancing the quality of life for patients with complicated ankle conditions. This study further shows that fibula flaps are safe and effective in patients undergoing ankle arthrodesis.
Patient Characteristics
| Case No. | Age/Gender | Past Medical History | Smoking History | Number of Surgeries (prior to fibula flap) | Etiologies
|
1
| 53/M | Diabetes Mellitus
Gout
Hypertension | No | 4 | Right subtalar and ankle fusion
Diabetic ulcer |
| 2 | 69/M
| Rheumatoid arthritis
Gout
Bladder Cancer
Hypertension
Hyperlipidemia
| Yes | 6 | Left pilon fracture
|
| 3 | 71/M
| Hypertension | No | 5 | Nonunion of tibia fracture and ankle fusion
|
| 4 | 69/M
| Hypertension | No | 10 | Traumatic right open talus fracture
|
Case 2. Intraoperative demonstration of vascularized free fibula osteocutaneous flap
Case 4. Preoperative planning and intraoperative demonstration of pedicled fibula flap
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