The fibula-flexor hallucis longus osteomuscular flap

Area of Science:

• Orthopedic Surgery
• Reconstructive Surgery
• Vascularized Tissue Transfer

Background:

• Limb salvage procedures for extensive bone and soft tissue loss often necessitate multiple surgical interventions.
• Achieving both bony continuity and adequate soft tissue coverage presents a significant reconstructive challenge.

Purpose of the Study:

• To introduce and evaluate the efficacy of a novel fibula-flexor hallucis longus osteomuscular flap for single-stage limb salvage.
• To assess the flap's ability to provide both vascularized bone and soft tissue coverage.

Main Methods:

• A fibula-flexor hallucis longus osteomuscular flap, based on peroneal vessels, was utilized in five patients.
• The flap was covered with a split-thickness skin graft.
• Vascularity of the fibular graft was monitored.

Main Results:

• The study included five patients with average bone defects of 8.3 cm and associated soft tissue/skin loss.
• Four patients achieved clinical and radiological union with excellent soft tissue coverage and regained a normal gait.
• One patient required secondary amputation due to diffuse coagulopathy.

Conclusions:

• The fibula-flexor hallucis longus osteomuscular flap is a viable option for single-stage limb salvage, effectively restoring bone and soft tissue.
• The flap offers a dependable vascularized bone graft with muscle coverage, minimal donor site morbidity, and allows for graft vascularity monitoring.