Role of Free Iliac Crest Flap in Foot and Ankle Reconstruction

J Reconstr Microsurg. 2016 Jun;32(5):386-94. doi: 10.1055/s-0036-1571441. Epub 2016 Feb 5.

Abstract

Background Reconstruction of extensive bone and compound defects in the foot and ankle is challenging. This cross-sectional study aimed to assess the outcomes of free iliac crest flap in foot and ankle reconstruction. Methods We retrospectively reviewed patient records and identified 13 cases with 1 osseous and 12 composite free iliac crest grafts for compound fracture (n = 3) or sequelae (n = 10) in the foot and ankle. We applied the visual analogue scale foot and ankle, the Oswestry disability index, and the 15D health-related quality of life (HRQoL) instruments. Results The average follow-up period was 3.9 years (range, 1.3-8.0 years). Four patients underwent early reoperations; venous and arterial reanastomosis (n = 1), minor wound revision (n = 2), or flap reconstruction due to partial necrosis of the skin island (n = 1). The median time to bone union was 23 months (range, 7-46 months). One permanent pseudoarthrosis occurred. One patient underwent late below-knee amputation due to chronic pain and functional impairment. One patient required flap reconstruction due to a late donor-site defect. Seven patients completed the questionnaires on an average of 14.7 years postoperatively (range, 2.0-26.9 years). Noted impairment of the donor site and of the reconstructed limb ranged from none to significant. Five (out of seven) patients had a HRQoL comparable to that of an age-standardized general population. Conclusions The free iliac crest flap is a feasible option for extensive compound fractures and bone-healing complications in the foot and ankle. It can also be used to achieve ankle arthrodesis when other techniques have failed and in patients at high risk for amputation.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Ankle Injuries / physiopathology
  • Ankle Injuries / surgery*
  • Bone Transplantation / methods*
  • Cross-Sectional Studies
  • Finland / epidemiology
  • Foot Injuries / physiopathology
  • Foot Injuries / surgery*
  • Fracture Healing
  • Fractures, Open / physiopathology
  • Fractures, Open / surgery*
  • Humans
  • Ilium / transplantation*
  • Male
  • Microsurgery*
  • Middle Aged
  • Reconstructive Surgical Procedures*
  • Recovery of Function
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult