Functional Total Heel Reconstruction with a Fibular Osteomyocutaneous Flap

Abstract

The fibular osteocutaneous flap is a versatile option for a range of reconstructive challenges. In this report, a novel osteocutaneous fibular flap in which a V-shaped strut of fibula was used to reconstruct the weight-bearing function of the calcaneus has been described. The case raised interesting questions about the vascularity of the fibular flap, which we addressed with an anatomic study of the lower leg. Eight cadavers were injected with the modified lead oxide-gelatin mixture. Two cadavers were selected for three-dimensional reconstructive modeling. Dissections of each layer were performed to outline the course of every perforator in the lateral leg and the region of the ankle. The peroneal artery originated from 5.0 +/- 1.0 cm inferior to the lateral fibular tuberosity (diameter of 2.0 +/- 0.4 mm). The artery gave off 7.6 +/- 1.8 branches and provided blood supply to the fibula bone and its adjacent soft tissue. Proximal perforators from the peroneal artery were large and consistent. Based on the success of this clinical case and the details of the vascular anatomy, the authors feel that distally based osteocutaneous fibular flaps with a V-shaped strut of fibula offer a novel option for reconstruction of complex defects in the heel area in which there are both bony and soft tissue defects.