Reconstruction with vascularized medial femoral condyle flaps in hindfoot and ankle defects: A report of two cases

Mattiassich, Georg; Marcovici, Lucian Lior; Dorninger, L.; Kerschhagl, Martina; Buerger, Heinz; Kroepfl, Albert; Larcher, Lorenz

doi:10.1002/micr.22286

Cited by 16 publications

(3 citation statements)

References 34 publications

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“…This option with low donor-site morbidity has many advantages, providing a composite graft for more complex defects including cartilage, if needed. 6 In other reports, the proximal head of fibula has been employed to restore a composite bone and soft tissue defect of the medial malleolus with good results. 7,8 More recently, latissimus dorsi flap plus scapula or with rib has been used for composite reconstruction in the lower limbs with good results.…”

Section: Discussionmentioning

confidence: 99%

Composite Compound Free Flaps for Lateral Malleolar Reconstruction

Battiston

Pugliese

Artiaco

et al. 2016

J Reconstr Microsurg Open

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).Shortening or absence of the distal fibula may cause a clinically valgus hindfoot owing to the talar abduction and lateral rotation.1,2 A displacement of 1 mm or 30-degree lateral rotation could alter the load distribution and lead to an abnormal articular stress causing subsequent arthritis. 3-5In case of loss of both bone and soft tissue, a reconstructive treatment is mandatory in order to restore skin coverage and a functional ankle with long-term stability.We present two results of a one-stage reconstruction of the complex lateral malleolus traumatic defect with two different microsurgical composite compound flaps. Patients and Method Case 1A 25-year-old man with a subtotal defect of the left lateral malleolus and a 10 Â 6 cm skin defect because of a motorbike accident was treated with a combined iliac crest bone and iliacus muscle flap plus a split-thickness skin graft, revascularized in an end-to-end fashion on the peroneal vessels.Two screws were used to lock the iliac graft and reconstruct the tibiofibular syndesmosis (TFS). This decision was made intraoperatively because of impairment of ligamentous structures and instability of the ankle. Screws were removed 90 days after the procedure.At 5-month control, magnetic resonance imaging (MRI) showed good morphology of the articular surface of the ankle joint. At 13-year control, X-ray images showed a tibiofibular arthrodesis and no signs of arthritis with a flexo-extension of the tibiotalar joint comparable to the contralateral one (►Figs. 1 and 2). Case 2An 11-year-old girl presented a traumatic defect of partial left lateral malleolus with an associated 12 Â 22 cm skin defect, as a result of a car accident. We performed a free combined serratus muscle and ninth rib bone flap plus a split-thickness skin graft, revascularized in an end-to-end fashion on the anterior tibial vessels. Plate was employed to give stability and external support, thereby allowing an early mobilization.The plate and screws were removed on day 180. Clinical control showed good mobility and stability of the ankle. The flap was too bulky, and required secondary liposuction to improve the cosmetic result.At 7-year follow-up, X-ray images showed a well-integrated rib with a restored continuity of the bone and preservation of TFS. Plantar flexion of the ankle was 50 degrees and dorsal flexion 10 degrees (►Figs. 3 and 4). DiscussionLoss of tissue in the foot and ankle region represents a challenging problem because of the small number of local flaps available close to the structures involved in walking and load bearing.In case 1, as the tibiofibular ligaments were severely damaged, we fixed the bone with screws passing through three cortical structures for a tighter reconstruction to perform a tibiofibular arthrodesis leaving the tibiotalar joint free. The function and mobility of the ankle were good, and the patient did not experience any problems from the procedure in his daily life.In case 2, we proposed to perform bone synthesis with plate and screws, which would then be removed lat...

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Section: Discussionmentioning

confidence: 99%

Composite Compound Free Flaps for Lateral Malleolar Reconstruction

Battiston

Pugliese

Artiaco

et al. 2016

J Reconstr Microsurg Open

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“…Sub‐talar articulation was limited by 50% compared to the contralateral. She was scheduled for a reconstruction of the talus by press‐fit with a free medial corticocartillagineousperiosteal femoral condyle flap (Mattiassich et al, 2014; Windhofer et al, 2022) with thin periosteal flaps to reconstruct the tibio‐talar joint and subastragalic joint.…”

Section: Case Reportmentioning

confidence: 99%

“…Sub-talar articulation was limited by 50% compared to the contralateral. She was scheduled for a reconstruction of the talus by press-fit with a free medial corticocartillagineousperiosteal femoral condyle flap(Mattiassich et al, 2014;Windhofer et al, 2022) with thin periosteal flaps to reconstruct the tibio-talar joint and subastragalic joint.The surgical procedure consisted in orthopedic and reconstructive steps in a single surgical time. The anterolateral access at the peroneal malleolus was performed.…”

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confidence: 99%

A chimeric medial femoral condyle chondro‐osseus flap with two thin periosteal flaps to reconstruct partial necrosis of talar body: A case report

Alice Letizia,

Sara,

Stefano

et al. 2023

Microsurgery

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Total talar extrusion is a rare complication of high‐energy traumas. A consequence of this injury can be avascular necrosis (AVN) of the talus. Patients are confronted with pain, limited range of motion and post‐traumatic arthritis. As AVN progresses the talus is gradually destroyed. This report presents the use of a chimeric medial femoral condyle chondro‐osseus flap with two thin periosteal flaps to increase vascular supply to the traumatized area, accelerate bone formation, flap integration, and restore articular surfaces in a patient with partial necrosis of talar body. The patient was a 26‐year‐old female with open left lateral talar extrusion after a motor‐vehicle accident that developed a partial avascular necrosis, at the level of the subtalar and ankle joint with altered talar dome surface with partial depression of 2 cm. The patient was in pain and not able to walk. The medial femoral condyle chondro‐osseus portion was placed in the talar dome depression to restore the subtalar joint, the periosteal flaps were placed on top to reconstruct the ankle joint restoring the articular surfaces and the correct weight‐bearing distribution. No complications or morbidity of donor site were observed. One year after the operation, the patient walks free, without pain. Post‐operatory x‐ray performed, evidenced progressive bone healing and reduction of the AVN. In the intent of performing a joint‐saving procedure, the presented chimeric flap might be effective in the short‐term with excellent clinical and radiographic outcomes.

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