Free Vascularized Fibular Graft for Distal Tibial and Ankle Arthrodesis

Background  The use of free vascularized fibular graft (FVFG) for proximal and mid-shaft tibial reconstruction is well documented in the literature. However, literature documenting distal tibial and proximal ankle reconstruction using this technique is lacking. The purpose of this case report is to demonstrate the osteocutaneous fibular free flap as a viable limb-sparing option to patients who previously required amputation in similar circumstances. Methods  The patient is a 39-year-old man who sustained a traumatic distal tibial pilon fracture. He underwent open reduction and internal fixation, which was complicated by osteomyelitis requiring multiple debridements and ultimately, resection of necrotic tissue. The resulting distal tibial defect measured 12 cm, including the talus. In an attempt to salvage the extremity, an FVFG was performed using the contralateral fibula. The harvested fibula was inserted proximally into the intramedullary canal of the tibia and impacted distally into the talar dome. Results  To date, the patient's postoperative course was notable for minor wound healing issues which resolved. Postoperative computed tomography confirmed fusion, allowing for weight-bearing and removal of the external fixator. Conclusion  Reconstruction of distal tibial defects with ankle involvement is a challenging operation for orthopedic and plastic surgeons. We describe a case in which a 12 cm tibial defect in conjunction with a talar defect was successfully reconstructed with a free vascularized fibular graft. We believe that this is a safe and viable option for those wishing to avoid amputation.