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 × 8 cm to 24 × 10 cm, and the sizes of the LD and ALT flaps were from 12 × 9 cm to 24 × 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. © 2009 Wiley‐Liss, Inc. Microsurgery, 2009.