[Compound grafting of vascularized fibular head and flaps to repair complicated lateral malleolus defects].
OBJECTIVE
To investigate the method and effect of compound grafting of vascularized fibular head and flaps to repair complicated lateral malleolus defects.


METHODS
From July 2000 to April 2006, 6 patients with lateral malleolus bone defect underwent the repairing treatment. There were 5 males and 1 female, aged 9-47 years. The causes of injuries was traffic accident in 4 cases and crash in 2 cases. And 5 cases were in the left side and 1 in right side. The bone defect ranged 3.5-8.5 cm in size and the skin defect ranged 14 cm x 4 cm-18 cm x 7 cm in size. The time from injury to surgery ranged from 15 to 30 days. The complicated lateral malleolus defects were repaired by transplanting the fibular head pedicled with the lateral inferior genicular artery 5-10 cm, and the peroneal perforator flaps or latissimus dorsi flaps 16 cm x 5 cm-20 cm x 8 cm. The raw surfaces of donor site were inflated and packaged with intermediate split thickness skin graft.


RESULTS
One flap with 1 cm distal edge dry necrosis healed after change of dressing and others all survived. The free skin grafts survived and the incision healed by the first intention. All the cases were followed up for 4 to 15 months, and all patients achieved the bony healing within 8-16 weeks and the transplanted fibular head grew well. The shape of reconstructed lateral ankles was similar to the normal one and the ankle mortise moved well. The texture of flaps was soft without diagnosis and abrasion. According to Baird-Jackson criterion, the results were excellent in 3 cases, good in 2 cases and fair in 1 case and the excellent and good rate was 83.3%.


CONCLUSIONS
The fibular head pedicled with the lateral inferior genicular artery has good blood supply and the reconstructed lateral malleolus is similar to the normal. The peroneal perforator flaps and latissimus dorsi flaps have adequate blood supply and big dermatomic area. So this operation is an effective method to repair lateral malleolus defect.
Zhang
Yan
Y
Department of Orthopedics, Sixth People's Hospital of Shanghai Jiaotong University, Shanghai 200233, PR China.
Cai
Peihua
P
Ruan
Hongjiang
H
Liu
Shenghe
S
Wang
Yinfeng
Y
Cai
Yimin
Y
D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000601:surgery*; D016025:Bone Transplantation; D002648:Child; D005260:Female; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016038:Skin Transplantation; D017695:Soft Tissue Injuries / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply