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Related Concept Videos

Bones of the Lower Limb: Tibia and Fibula01:10

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The tibia is the main weight-bearing bone of the lower leg. It is larger than the fibula with which it is paired. The tibia is also the second longest bone in the body and is located right below the skin. The proximal end of the tibia forms the medial and the lateral condyle, which articulates with the condyles of the femur to form the knee joint. Between the articulating surfaces is the irregular elevated area known as the intercondylar eminence that serves as the inferior attachment point for...
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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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Distally Based Pedicled Fibula Flap for Reconstruction of Infected Charcot's Midtarsal Collapse-Diabetic Rocker

T M Balakrishnan1, Sathya Pakkiri1, Arounkumar Nagalingam1

  • 1Department of Plastic and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India.

Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India
|April 5, 2021
PubMed
Summary

This study presents a new surgical method for diabetic rocker bottom feet with infection. The distally based pedicled fibula flap achieved a 96.4% limb salvage rate in 28 patients.

Keywords:
charcot’s jointdiabetic foot syndromedistally based pedicled fibula flapinfected diabetic rocker bottom footorthoplastic approach

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Area of Science:

  • Orthoplastic surgery
  • Diabetic foot complications
  • Reconstructive surgery

Background:

  • Diabetic rocker bottom foot with secondary infection poses a significant challenge for reconstructive surgeons.
  • Salvaging these feet requires specialized expertise to prevent amputation.

Purpose of the Study:

  • To evaluate the efficacy of a staged reconstruction protocol using a distally based pedicled fibula flap for infected diabetic rocker bottom feet.
  • To assess the limb salvage rate and functional outcomes in patients undergoing this reconstructive approach.

Main Methods:

  • A retrospective study of 28 diabetic patients with secondarily infected Charcot's degenerated rocker bottom feet.
  • A three-stage surgical reconstruction: Stage 1 (debridement and external fixation), Stage 2 (distraction and arthroereisis), Stage 3 (distally based pedicled fibula flap for reconstruction).

Main Results:

  • The average Musculoskeletal Tumor Society Rating (MSTSR) score was 27.536 at an average follow-up of 30.5 months.
  • The limb salvage rate achieved with this protocol was 96.4% (p = 0.045).

Conclusions:

  • The described staged reconstruction protocol using a pedicled fibula flap is effective for salvaging infected diabetic rocker bottom feet.
  • This orthoplastic approach offers a valuable new option for reconstructive surgeons dealing with complex diabetic foot deformities.