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

Abstract

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.

Anatomic Reconstruction of Lateral Ankle Ligaments and Both Peroneus Tendons After Open Fracture Dislocation of the Ankle: A Case Report

“…Various reconstructive procedures are available for the treatment of extensive soft tissue injuries of the ankle. 5,11,14 Depending on the extent of the remaining normal tissue, surgeons should choose the most appropriate procedures. To achieve full functional recovery, it is important to stabilize the ankle without limiting the range of motion.…”

“…The treatment of extensive soft tissue defects of the ankle resulting from high-energy trauma or tumor resection is challenging. 5,11,14 Tendons and ligaments are essential for normal movement and stability of the ankle, and loss of these tissues requires functional reconstruction. Anatomic reconstruction using a tissue graft to treat chronic lateral ankle instability or peroneus tendon injury has gained popularity and has favorable clinical results.…”