J reconstr Microsurg 2005; 21: 371-376 DOI: 10.1055/s-2005-915204
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.
Reconstruction of the Form and Function of Lateral Malleolus and Ankle Joint
Kensuke Kiyokawa1, Shinsuke Tanaka1, Yuichiro Kiduka1, Yojiro Inoue1, Toshihiko Yamauchi1, Yoshiaki Tai1
1 Department of Plastic and Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan

ABSTRACT

Soft-tissue reconstruction alone cannot obtain normal ankle function in patients with large defects in the area of the lateral malleolus. The authors report a functional reconstructive method for the lateral malleolus, utilized in a male patient whose osteosarcoma in the fibula was resected with surrounding soft tissue. In order to reconstruct the lateral malleolus, the remaining half of the fibula at the knee was removed, and the fibular head was fixed with the tibia at the ankle joint. Ligaments were reconstructed with tendon grafts. Skin and soft-tissue defects were reconstructed with a combined composite flap comprised of a latissimus dorsi myocutaneous flap and a serratus anterior muscle flap. Dead space around the bone graft was filled with the serratus anterior muscle flap that was divided into two portions. The surface was covered with the latissimus dorsi myocutaneous flap. The patient regained almost normal function of the ankle joint. This technique would be a useful functional reconstructive method for patients with large defects in the area of the lateral malleolus.

KEYWORDS

Functional reconstruction of ankle joint - combined composite flap - divided serratus anterior muscle flap