Orthoplastic tarsal reconstruction using a chimeric vascularized bone graft in a heavy smoker: a case report

Vascularized reconstruction of bone defects in the foot after osteomyelitis is a complex procedure that requires an orthoplastic collaboration. This case demonstrates the successful use of a free osteocutaneous fibula flap with a perforator-based skin island to reconstruct the medial midfoot following a late-onset infection after fusion for osteonecrosis. A 63-year-old woman presented after osteonecrosis and failed surgeries, including talonavicular and naviculocuneiform arthrodesis complicated by infection. Given the patient's smoking and infection history, revision using avascular bone grafts was not an option. A vascularized fibula graft and a perforator-based skin island were used to reconstruct the medial column and the soft tissue. The patient was free of pain and had full ankle mobility at 12 months. Reconstructing large postosteomyelitic foot defects is challenging. Vascularized bone and soft tissue flaps are essential to ensure healing and stability. Proper risk stratification and backup surgical strategies are critical for high-risk patients.