Vascular bone transfer options in the foot and ankle: A retrospective review and update on strategies

BACKGROUND: The foot and ankle area has a tenuous blood supply that can easily be damaged with trauma or open exposures. The navicular and talus are susceptible to avascular necrosis, making arthrodesis difficult. In addition, in this region, large bone gaps occur as a result of avascular necrosis, trauma, or infection. Often, vascularized bone flaps are required for reconstruction or salvage. METHODS: A retrospective review of all vascularized bone flaps to the foot and ankle performed by the senior surgeon (L.S.L) from July of 2006 to July of 2012 was performed. Twelve cases were identified (seven fibula flaps and five medial femoral condyle flaps). Indications included talus avascular necrosis with tibiotalar and subtalar arthritis (n = 8), talus avascular necrosis with tibiotalar arthritis (n = 1), navicular avascular necrosis (n = 1), talus persistent nonunion (n = 1), and a traumatic bone defect (n = 1). RESULTS: There were no flap failures or thrombotic events. Ankle stabilization was performed with plates (n = 5), compression screws (n = 2), external fixator (n = 4), and a cast (n = 1). There were three complications requiring return to the operating room. All patients ultimately obtained union, and full weight bearing was allowed at 18.7 ± 13.6 weeks after surgery. CONCLUSIONS: The authors have successfully used the medial femoral condyle flap and fibula flap for tibiotalar arthrodesis, pantalar arthrodesis, navicular revascularization, and persistent nonunion of the talus. The medial femoral condyle is ideal when a small segment of vascularized bone is required, but when structural support is necessary, the fibula offers a larger cortical surface area, providing more rigidity. Both flaps are valid options for foot and ankle reconstruction and salvage.