ARTHRODESIS OF THE ANKLE WITH A FREE VASCULARIZED AUTOGENOUS BONE-GRAFT - RECONSTRUCTION OF SEGMENTAL LOSS OF BONE SECONDARY TO OSTEOMYELITIS, TUMOR, OR TRAUMA

Reconstruction after massive loss of bone about the ankle is difficult because of the limited amount of surrounding soft tissue and because of technical factors pertaining to adequate internal or external fixat ion. Conventional techniques are often unsuccessful because of the fre quency of associated deep infection and of previous operative procedur es, In this report, we describe eleven patients with a large defect of the distal aspect of the tibia who were managed at our institution wi th arthrodesis of the ankle with free vascularized bone graft. The def ect was related to a tumor resection; an acute open fracture with bone and soft-tissue loss caused by a shotgun injury; or osteomyelitis, ei ther alone or in combination with septic arthritis, with chronic non-u nion following a fracture of the ankle. A free fibular graft was used in osseous defects that were larger than four centimeters, and a free iliac-crest graft was used in smaller defects. Osteocutaneous or osteo muscular flaps were constructed to cover accompanying soft-tissue defe cts when necessary. A successful fusion was obtained in nine of the el even patients, The results in the remaining two were regarded as clini cal failures, and a below-the-knee amputation was performed. One amput ation was done because of recurrent infection and the other, because o f failure of the fracture to unite after four years.