Calcaneal Reconstruction With Microvascular Double/single Barrel Fibula Osteocutaneus Flap: A Limb- Preservation Case Series
Michelle Coriddi, MD, Amanda Brunswick, PA, Said Atway, DPM, Ian Valerio, MD, Rajiv Chandawarkar, MD.
Ohio State University, Columbus, OH, USA.
PURPOSE: Calcaneal destruction commonly occurs in diabetics, and trauma (including warfront IED explosions). Calcaneal resection usually necessitates a below-knee amputation - the central weight-bearing mechanism is lost and reconstructive choices are limited.
METHODS: Here we present two cases of calcaneal reconstruction, using double/single-barreled fibular osteocutaneous free flap.
RESULTS: Two patients who underwent near-total calcanectomy for osteomyelitis (complications from infected fracture-hardware) are described. Alternative to reconstruction was below-knee-amputation since wound care with chronic antibiotic suppression were unsuccessful. Reconstruction using a free fibular osteocutaneous flap was undertaken. Osteotomies were performed to create a double-barrel fibula, taking care to preserve periosteum. The tips of the fibula were shaped into pencil-tip cones that were then invaginated into corresponding conical cavities burred into the calcaneal remnant to wedge the double barrel fibula flap. This measure increased bone-to-bone contact promoting new-bone formation and increasing stability for weight-bearing. The orientation of the fibula vis-à-vis the heel was also carefully planned using physiologic models of weight-bearing in the adult foot. Nonsurgical donor-site wound complications and a partial skin-paddle loss occurred in one patient. Both patients healed unremarkably and are fully weight-bearing and ambulatory.
CONCLUSION: Calcaneal reconstruction is possible with free fibula bone and must be considered as an alternative to amputation. A double-barrel design with careful attention to orienting the fibula to closely resemble the anatomy of the weight-bearing posterior portion of the calcaneum allows for reconstruction of larger defects, creates a physiologic weight-bearing bone with excellent results. It is a useful alternative to limb loss.
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