The use of free fibula-flexor hallucis longus osteomuscular flap for calcaneal reconstruction after partial calcanectomy for the chronic osteomyelitis: A case report

Ribeiro, Luís Mata; Casal, Diogo; Ferreira, João Amaral; Costa, Daniel Sá da; Lacerda, João F.

doi:10.1016/j.ijscr.2019.10.046

Cited by 6 publications

(11 citation statements)

References 16 publications

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“…In cases of OC, the primary surgical goal is the complete removal of necrotic tissues; however, more radical interventions are sometimes necessary. 5 , 7 , 26 , 29 , 41 , 42 …”

Section: Discussionmentioning

confidence: 99%

The Concept of Treatment for Surgical Infection in the Hindfoot

Alizade,

Aliyev,

Alizada

2024

Foot & Ankle Orthopaedics

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Background: Chronic osteomyelitis of the calcaneus (OC) and open infected calcaneal fractures, especially when complicated by infected soft tissue defects, present significant surgical challenges. Accepted recommendations for the surgical treatment of this pathology are yet to be established. Methods: Drawing from our experience and the consensus among experts, we have developed a concept for selecting optimal, well-known surgical approaches based on the specific pathologic presentation. This concept distinguishes 4 main forms of hindfoot infection: infected wounds, open infected fractures, OC, and their mixed forms. Patients with conditions that could confound the treatment outcomes, such as diabetes mellitus and neurotrophic diseases, were excluded from this analysis. We present a retrospective analysis of the treatment outcomes for 44 patients (4 women and 40 men) treated between 2009 and 2022 using some refined surgical techniques. Treatment success was evaluated based on the absence of disease recurrence within a 2-year follow-up, the avoidance of below-knee amputations, and the restoration of weightbearing function. Results: The treatment results were considered through the prism of our proposed concept and according to the Cierny-Mader classification. There were 4 instances of disease recurrence, necessitating 6 additional surgeries, 2 of which (4.5% of the patient cohort) resulted in amputations. In the remaining cases, we were able to restore weightbearing function and eliminate the infection through reconstructive surgeries, employing skin grafts when necessary. Conclusion: Surgical infections of the hindfoot area remain a significant challenge. The strategic concept we propose for surgical decision making, tailored to the specific pathology, represents a potential advancement in addressing this challenge. This framework could provide valuable guidance for orthopaedic surgeons in their clinical decision-making process. Level of Evidence: Level IV, case series.

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“…In cases of OC, the primary surgical goal is the complete removal of necrotic tissues; however, more radical interventions are sometimes necessary. 5 , 7 , 26 , 29 , 41 , 42 …”

Section: Discussionmentioning

confidence: 99%

The Concept of Treatment for Surgical Infection in the Hindfoot

Alizade,

Aliyev,

Alizada

2024

Foot & Ankle Orthopaedics

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“…When looking at the use of femoral head allografts to augment acetabular bone loss post-THA, Butscheidt et al 20 found that the allograft showed intact structure, significantly higher mineralization than the host bone, and an average of 7.2 mm of ingrowth with a mean follow-up of 12.9 years. Subtalar, 19 calcaneocuboid, 19 , 21 and fusions to the remaining calcaneus 7 , 8 have been used to help manage large defects of the calcaneus. We decided upon a subtalar fusion through the allograft and remaining calcaneus as it would preserve ankle joint range of motion and inversion/eversion ability while providing strong hindfoot structural support.…”

Section: Discussionmentioning

confidence: 99%

Calcaneal reconstruction using a femoral head allograft and biologic adjuncts: A case report

Weiss

Konopka

Azam

et al. 2022

SAGE Open Medical Case Reports

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We present a case of calcaneal reconstruction after both an improvised explosive device injury and subsequent salvage procedures left the patient with a large calcaneal defect and damaged hindfoot soft tissue. A subtalar arthrodesis was performed with a femoral head allograft, where it was fused to the remaining calcaneus and superiorly through the talus, to successfully reconstruct this defect. Demineralized bone matrix, bone morphogenetic protein, and concentrated bone marrow aspirate were also added as adjuncts to promote bone remodeling. At final follow-up, the patient denied pain, was fully weight-bearing, and had resumed an active lifestyle. Level of Evidence: Level V, Case Report

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“…Some authors argued for harvesting muscle to fill the dead space in the floor of the mouth, 18 and antrum, after partial calcanectomy. 6 …”

Section: Discussionmentioning

confidence: 99%

“… 2 The fibula osteo-cutaneous flap is used for reconstruction of many anatomical defects. They are used in reconstruction of mandible, maxilla, 3 clavicle, 4 long bones (humerus, radius, ulna, femur, tibia), 5 vertebrae, calcaneum, 6 etc. The length of the bone that can be harvested, presence of muscle, and large skin paddle that can be harvested have added to the advantages of using fibula flap for reconstruction purposes.…”

Section: Introductionmentioning

confidence: 99%

Fibula Musculo-Osteocutaneous Flap with Full Thickness of Flexor Hallucis Longus Muscle

Venkatesh

Kumaraswamy

Shivalingappa

et al. 2021

wjps

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BACKGROUND Fibula flap has been a gold standard method for reconstruction of the mandible. It has been used for reconstruction of maxilla as well as long bones, effectively. Fibula flap in selected cases has been used as a pedicled flap. The flexor hallucis longus muscle has been used to obliterate the dead space during the reconstruction. With a wide range of indications, the use of flexor hallucis muscle has studied for the reconstruction. METHODS In a retrospective case record analysis study, 38 subjects were enrolled, included 32 patients with reconstruction of mandible, 1 patient with reconstruction of maxilla, 4 patients with 3 free flaps and 1 pedicled flap with reconstruction of the tibia. RESULTS The success rate was 89%, with 4 flap failures. The muscle was used for reconstruction of the tongue, floor of the mouth, antrum, and to cover the fibula graft. CONCLUSION Flexor hallucis longus muscle harvested with the flap could decrease the operative time, ease the harvest, and fill the dead space during reconstruction.

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The use of free fibula-flexor hallucis longus osteomuscular flap for calcaneal reconstruction after partial calcanectomy for the chronic osteomyelitis: A case report

Abstract: HighlightsCalcaneal osteomyelitis is difficult to eradicate.Calcaneal debridement and infection control are critical.Osteomuscular flaps offer a stable and effective reconstruction.

Cited by 6 publications

References 16 publications

The Concept of Treatment for Surgical Infection in the Hindfoot

The Concept of Treatment for Surgical Infection in the Hindfoot

Calcaneal reconstruction using a femoral head allograft and biologic adjuncts: A case report

Fibula Musculo-Osteocutaneous Flap with Full Thickness of Flexor Hallucis Longus Muscle

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