Medial malleolus and deltoid ligament reconstruction in open ankle fractures with combination of vascularized fibular head osteo-tendinous flap and free flap transfers.

Treatment of the traumatic bone and soft tissue defect of the medial ankle is a challenge in reconstructive orthopedic surgery. In this report, we described a novel reconstruction procedure for the medial malleolus reconstruction using microsurgical transfer of the fibular head osteo-tendinous flap combined with a free latissimus dorsi flap (free LD flap) or a free anterolateral thigh flap (free ALT flap) in six patients. The sizes of the wounds ranged from 10 x 8 cm to 24 x 10 cm, and the sizes of the LD and ALT flaps were from 12 x 9 cm to 24 x 12 cm. All transplants survived. Five patients had primary wound healing. One patient had fibular graft and soft tissue infection that caused delayed healing. On average 4 months after surgery, all patients were able to stand and walk without crutch assistance. With a mean follow-up of 3.5 years (range, 1-5 years), all patients achieved stable ankles and were satisfied with the range of motion with excellent American Orthopedic Foot and Ankle Society functional scores (> 85). The fibular head resembles the medial malleolus in morphology. Vascularized fibular head transfer combined with a free flap provides satisfactory results for complex medial malleolus reconstruction.