Reverse Transfer of the Proximal Vascularized Fibula to Reconstruct the Lateral Malleolus: A Case Report and Literature Review

Gao, You-Shui; Zhang, Changqing; Sheng, Jifang

doi:10.1053/j.jfas.2015.02.004

Cited by 7 publications

(14 citation statements)

References 16 publications

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“…The reverse-flow VFEG operative technique used in this patient is a one-stage procedure requiring no microvascular anastomosis which cannot only shorten operating time, but also reduce factitious damage of vessels 16 . However, it was controversial as to which artery was chosen to nourish graft.…”

Section: Discussionmentioning

confidence: 99%

Lateral Malleolus Reconstruction After Tumor Resection in Children: A Case Report and Literature Review

Long

Chen

et al. 2022

Orthopaedic Surgery

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Background Pediatric reconstruction of lateral malleolus was necessary and challengeable. Up to now, vascularized fibular was the optimal graft to reconstruct epiphyseal defection. However, the sophisticated microvascular operation has limited the wide application of this technique. Case Presentation We present the case of a 9‐year‐old boy with Ewing sarcoma in left distal fibula. In order to restore the growth capacity, we used reverse‐flow vascularized fibular epiphyseal graft with tibialis anterior artery to reconstruct the bone defect after tumor resection with no microvascular anastomosis. More than 4 years after the operation and adjuvant chemotherapy, the patient was free of pain and recurrence, and the function and stability of ankle joint was perfect. Radiology examination revealed satisfied bony union of fibula and normal growth of the fibular head transplant. Conclusions The advantage of reverse‐flow vascularized fibular epiphyseal graft is requiring no microvascular anastomosis which could not only shorten operating time, but also reduce factitious damage of vessels. This report presented that this technique might be an available option for reconstruction of lateral malleolus in children.

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Section: Discussionmentioning

confidence: 99%

Lateral Malleolus Reconstruction After Tumor Resection in Children: A Case Report and Literature Review

Long

Chen

et al. 2022

Orthopaedic Surgery

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“…First, we had enough bone length remnant to maintain the proximal 8 cm of the fibula and ensure the proximal tibiofibular stability. Second, the proximal fibula had an identical contour to the distal fibula and sufficient strength (Gao et al, 2016). Finally, it was located on the same side of the defect, preventing the risk of contralateral donor site damage that could occur if a contralateral fibula flap was used for reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Given the rarity of this tumor location (Niimi et al, 2008), the literature regarding this matter is scarce. Classical options described include ligamentoplasties to the lateral tibia using the distal peroneal or tibialis tendons (Capanna et al, 1986; Dieckmann et al, 2011; Durak et al, 1996; Lamb et al, 2021; Marcove & Rosen, 1980; Monson et al, 2014; Papagelopoulos et al, 2005; Shoji et al, 1970; Vaseenon et al, 2017; Yadav, 1981), tibiotalar arthrodesis (Dieckmann et al, 2011; Ozaki et al, 1997; Papagelopoulos et al, 2005; Perisano et al, 2012; Saadon et al, 2017; Wang et al, 2020; Yin et al, 2015; Yoshida et al, 2017), fixation of the proximal fibula to the tibia (CARRELL, 1938; Persson & Rydholm, 1979), prosthethic ankle joint replacement (Papagelopoulos et al, 2005; Perisano et al, 2012), reconstruction with distal fibular allografts (Jamshidi et al, 2013; Lubliner et al, 1985; Papagelopoulos et al, 2005; Perisano et al, 2012; Saadon et al, 2017; San‐Julian et al, 2008; Wang et al, 2020), contralateral fibular autografts (Wang et al, 2020), iliac crest bone grafts (Eger et al, 2004; Papagelopoulos et al, 2005; Perisano et al, 2012), rotating the ipsilateral proximal fibula 180° (Capanna et al, 1986; Dieckmann et al, 2011; Papagelopoulos et al, 2005; Perisano et al, 2012; Saadon et al, 2017; Wang et al, 2020), and pedicled or free fibular flaps (Bibbo et al, 2015; Cavadas & Thione, 2015; de Gauzy et al, 2002; Gao et al, 2016; Panuel et al, 1997; Papagelopoulos et al, 2005; Rajacic & Dashti, 1996). Furthermore, there are case series in young patients in which no ankle reconstruction was performed, wit...…”

Section: Introductionmentioning

confidence: 99%

Ankle joint salvage surgery with an ipsilateral mid‐fibula osteocutaneous free flap and contralateral anterolateral thigh free flap: A case report and literature review

et al. 2022

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The tibiofibular joint can be reconstructed after distal fibular sarcoma salvage surgery to maintain ankle stability and achieve early gait. Classical reconstructive options include ligamentoplasties, arthrodesis, prosthetic replacement, bone grafts, and pedicled ipsilateral or free contralateral fibular bone flaps. We present a novel strategy for reconstruction of the ankle in an elderly patient and a literature review. A 68-year-old man presented with a high-grade myxofibrosarcoma to his distal fibula.Wide resection of the tumor and adjacent structures left a 12 Â 12 Â 8 cm defect including the distal fibula (10 cm), a 2 cm fragment of the lateral cortex of the tibia, the lateral anterior and superficial posterior compartments, and the lateral compartment. A 3 cm distal fibula remnant was left in the ankle mortice. Reconstruction was performed using a free ipsilateral 13-cm diaphyseal osteocutaneous fibular flap telescoped into the distal fibula remnant and anastomosed to the anterior tibial artery. A pre-bent L-shaped locking plate was used to reconstruct a syndesmotic joint. A 21 Â 13 cm suprafascial ALT flap was anastomosed to the proximal stump of the peroneal artery to cover the soft tissue defect. The patient had no complications and was ambulating with full weight bearing by postoperative week 11. He received postoperative chemo and radiotherapy. Three years postoperatively, he is tumor free, has complete ankle ROM and stability, and ambulates with no restrictions. Limb sparing surgery with a functional tibiofibular joint reconstruction should be considered to attain an early functional recovery after distal fibula sarcomas resection.

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“…All of these techniques, at least theoretically, have different disadvantages. 2,4,7,14 Repair of a soft-tissue defect over the lateral malleolus secondary to severe trauma remains challenging for the orthopedic and plastic surgeon. Both lateral malleolus reconstruction and soft-tissue coverage are important for limb salvage.…”

Section: Discussionmentioning

confidence: 99%

“…The loss of stability and critical soft-tissue condition need reconstruction to achieve a stable ankle joint and sufficient skin coverage for this area. To overcome this problem, various methods have been described in different studies including ankle arthrodesis, 4 allografting, autologus iliac crest transplantation, 5 vascularized or nonvascularized proximal fibular graft, 1,2,7,9 scapular apophysis transplantation, 6 prosthetic reconstruction, 15 and combination reconstruction. 11 All of these techniques, at least theoretically, have different disadvantages.…”

mentioning

confidence: 99%

Soft-Tissue Reconstruction Without Fibular Reconstruction in Traumatic Injuries of the Ankle With Fibular Loss

et al. 2016

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Compound or complete loss of the lateral malleolus and distal fibula are relatively uncommon and usually caused by high-energy trauma. This remains a challenging problem for orthopedic surgeons. This can result in loss of ankle joint stability, persistent pain, abnormal gait, posttraumatic arthritis, or permanent disability. The loss of stability and critical soft-tissue condition need reconstruction to achieve a stable ankle joint and sufficient skin coverage for this area. To overcome this problem, various methods have been described in different studies including ankle arthrodesis, 4 allografting, autologus iliac crest transplantation, 5 vascularized or nonvascularized proximal fibular graft, 1,2,7,9 scapular apophysis transplantation, 6 prosthetic reconstruction, 15 and combination reconstruction. 11 All of these techniques, at least theoretically, have different disadvantages. We report 2 cases of distal fibular loss with soft-tissue defect due to severe trauma, which were treated by sural neurocutaneous island flap covering the wound without osseous reconstruction. We followed up one patient for 10 years and another for 5 years, respectively, with good clinical outcomes and without dislocation.

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Reverse Transfer of the Proximal Vascularized Fibula to Reconstruct the Lateral Malleolus: A Case Report and Literature Review

Cited by 7 publications

References 16 publications

Lateral Malleolus Reconstruction After Tumor Resection in Children: A Case Report and Literature Review

Lateral Malleolus Reconstruction After Tumor Resection in Children: A Case Report and Literature Review

Ankle joint salvage surgery with an ipsilateral mid‐fibula osteocutaneous free flap and contralateral anterolateral thigh free flap: A case report and literature review

Soft-Tissue Reconstruction Without Fibular Reconstruction in Traumatic Injuries of the Ankle With Fibular Loss

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