title: Subtalar fusion with iliac bone free flap after a recalcitrant nonunion: Report of two cases.
abstract: Fractures of the calcaneus are associated with secondary osteoarthritis of the subtalar joint. In a persistent nonunion, vascularized bone flaps offer superior biologic and mechanical properties as well as accelerates joint fusion and decreases morbidity. In this report, we present results of the use of vascularized iliac bone free flap for treating subtalar failed fusions in two patients. Two patients sustained calcaneal fractures due to foot trauma, which were initially or subsequently treated with subtalar arthrodesis. Case one developed septic subtalar nonunion during treatment and case two failed three attempts at subtalar arthrodeses. The iliac crest bone flap harvested measured 4 × 4 cm (case one) and 3 × 3 cm (case two). The flap was pedicled by the deep circumflex iliac artery, which was anastomosed to the anterior tibial artery at the recipient site. No flap donor or recipient site complications occurred. Fusion was confirmed on CT scan and weight bearing was initiated at 5-6 months. At latest follow up (1-2 years), no complications occurred. Our results show that subtalar nonunion treatment with a vascularized iliac bone flap may be feasible and such a reconstruction could be clinically successful. © 2015 Wiley Periodicals, Inc. Microsurgery 36:501-506, 2016.
authors.affiliation: Departments of Microsurgery Unit at Hospital Fremap Majadahonda, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Roger
authors.affiliation: Department of Orthopaedic Surgery at Saint Louis University School of Medicine, Saint Louis, MO. aworden33@gmail.com.
authors.forename: Alicia
authors.initials: A
authors.lastname: Worden
authors.affiliation: Department of Orthopaedic Surgery at Saint Louis University School of Medicine, Saint Louis, MO.
authors.forename: Joao
authors.initials: J
authors.lastname: Panattoni
authors.affiliation: Departments of Microsurgery Unit at Hospital Fremap Majadahonda, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Garcia
authors.affiliation: Departments of Orthopaedic Surgery at Hospital Ramon Y Cajal Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Aranda
authors.affiliation: Departments of Plastic Surgery at Hospital Ramon Y Cajal Madrid, Spain.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Delgado
mesh_terms: D000328:Adult; D001174:Arthrodesis / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery; D005599:Fractures, Ununited / Q000601:surgery*; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D013380:Subtalar Joint / Q000601:surgery*