Vascularized bone transfer for severe injury around the ankle

Severe injuries around the ankle are very difficult to treat. Although technically demanding, vascularized bone transfer has the potential to span bone defects, eradicate infection, and provide soft tissue coverage all in one stage. The fibula is the best choice for transfer as it produces the best results and the least donor site morbidity. Complications are reasonably common as in all complex reconstructive surgery, but in the properly selected patient this approach offers the best chance for salvage of a functional limb. The purpose of this review is to evaluate some of the various options available for managing severe injuries around the ankle with particular focus on vascularized bone grafts, particularly the vascularized fibular bone graft. Selection criteria, surgical timing, potential donor sites, as well as outcomes and possible complications are presented regarding the available options for vascularized bone grafts in managing severe ankle injuries.