Composite Compound Free Flaps for Lateral Malleolar Reconstruction

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] [4] [5]

In 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.

• References

• 1 Wiltse LL. Valgus deformity of the ankle: a sequel to acquired or congenital abnormalities of the fibula. J Bone Joint Surg Am 1972; 54 (3) 595-606
• 2 Lambert KL. The weight-bearing function of the fibula. A strain gauge study. J Bone Joint Surg Am 1971; 53 (3) 507-513
• 3 Kimizuka M, Kurosawa H, Fukubayashi T. Load-bearing pattern of the ankle joint. Contact area and pressure distribution. Arch Orthop Trauma Surg 1980; 96 (1) 45-49
• 4 Wang Q, Whittle M, Cunningham J, Kenwright J. Fibula and its ligaments in load transmission and ankle joint stability. Clin Orthop Relat Res 1996; (330) 261-270
• 5 Yablon IG, Heller FG, Shouse L. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg Am 1977; 59 (2) 169-173
• 6 Mattiassich G, Marcovici LL, Dorninger L , et al. Reconstruction with vascularized medial femoral condyle flaps in hindfoot and ankle defects: a report of two cases. Microsurgery 2014; 34 (7) 576-581
• 7 Liu Y, Zhang CJ, Fu XM, Wang JL, Wang CQ. Fibular head composite flap for bone and skin defect at medial malleolus in children: a report of 4 cases [in Chinese]. Zhonghua Zheng Xing Wai Ke Za Zhi 2011; 27 (2) 95-97
• 8 Wu SP. Clinical study of reconstructing the medial malleolus with free grafting of fibular head composite tendon bone flap. Chin J Traumatol 2008; 11 (1) 34-36
• 9 Junnila J, Repo JP, Mustonen A, Tukiainen EJ. Treatment of compound tibial fracture with free osteomuscular latissimus dorsi scapula flap. J Reconstr Microsurg 2015; 31 (3) 217-224
• 10 Sia WT, Xu GG, Puhaindran ME, Tan BK, Cheng MH, Chew WY. Reconstruction of extensive soft-tissue defects with concomitant bone defects in the lower extremity with the latissimus dorsi-serratus anterior-rib free flap. J Reconstr Microsurg 2015; 31 (6) 407-413