Arthrodesis of the ankle with a free vascularized autogenous bone graft: Reconstruction of segmental loss of bone secondary to osteomyelitis, tumor, or trauma

Reconstruction after massive loss of bone about the ankle is difficult because of the limited amount of surrounding soft tissue and because of technical factors pertaining to adequate internal or external fixation. Conventional techniques are often unsuccessful because of the frequency of associated deep infection and of previous operative procedures. In this report, we describe eleven patients with a large defect of the distal aspect of the tibia who were managed at our institution with arthrodesis of the ankle with free vascularized bone graft. The defect was related to a tumor resection; an acute open fracture with bone and soft-tissue loss caused by a shotgun injury; or osteomyelitis, either alone or in combination with septic arthritis, with chronic non-union following a fracture of the ankle. A free fibular graft was used in osseous defects that were larger than four centimeters, and a free iliac-crest graft was used in smaller defects. Osteocutaneous or osteomuscular flaps were constructed to cover accompanying soft-tissue defects when necessary. A successful fusion was obtained in nine of the eleven patients. The results in the remaining two were regarded as clinical failures, and a below-the-knee amputation was performed. One amputation was done because of recurrent infection and the other, because of failure of the fracture to unite after four years.