Reconstruction of the lateral malleolus using a reverse-flow vascularized fibular head: A case report

Abstract

We report a case of a 7-year-old girl in whom a vascularized fibular head with preserved epiphyseal and metaphyseal blood supply was used to reconstruct the missing lateral malleolus. Two-year follow-up showed good bony stability and growth potential of the transplanted epiphyseal plate.

Vascularized Fibular Epiphyseal Transfer for Pediatric Limb Salvage: Review of Applications and Outcomes

“…Oncologic indications most commonly included osteosarcoma and Ewing sarcoma. 2,3,5,6,[8][9][10][12][13][14][16][17][18][19]21,[23][24][25]27,[31][32][33][36][37][38]40 Congenital deformities included radial longitudinal deficiency and ulnar pseudarthrosis. 19,22,23,27,30,35 Traumatic injuries involved the lateral malleolus, calcaneus, radius, and ulna.…”

“…Table 1 details the summary of VFET technique considerations extracted from these articles to help guide surgical planning. 2,3,5–42…”

“… 19 , 22 , 23 , 27 , 30 , 35 Traumatic injuries involved the lateral malleolus, calcaneus, radius, and ulna. 6 , 15 , 20 , 24 , 27 Across all indications, the most common recipient site was the humerus.…”

“… 3 , 29 Harvesting the flap on the peroneal artery (PA), which provides the primary endosteal and periosteal blood supply to the fibular shaft, offered an easier dissection but less direct blood supply to the fibular head. 6 , 16 , 18 , 27 , 33 Several case series used a bi-pedicled approach using both the ATA and PA to optimize blood supply to the growth plate and fibular shaft. 5 , 30 , 32 , 37 , 38 Several authors have raised concerns about using a dual pedicle due to the increased complexity and potential morbidity at both the recipient and donor sites, such as anastomotic thrombosis and future complications associated with one-vessel runoff of the lower extremity.…”

“…VFET has also been used as an ipsilateral pedicled flap for reconstruction of the lateral malleolus and calcaneus without the necessity of microvascular anastomosis. 6 , 12 , 15 , 31 Santanelli di Pompeo et al performed a double barrel vascularized dual fibula transfer in which a VFET was connected in series with a contralateral free fibula flap for femur reconstruction. 18 …”