Vascularized Pedicled Fibula Onlay Bone Graft to Augment Complicated Tibio-talo-calcaneal Arthrodesis Stabilized with Retrograde Intramedullary Nail Fixation

摘要

In select high-risk limb salvage cases, the senior author has augmented tibio-talo-calcaneal arthrodesis procedures stabilized with retrograde intramedullary nail fixation with a vascularized pedicled fibular onlay bone graft. This is because tibio-talo-calcaneal arthrodesis stabilized with retrograde intramedullary nail fixation is associated with a high incidence of complications especially with bulk structural allograft. The fibula is mobilized on the musculo-periosteal perforating branches of the peroneal artery as a vascularized pedicle onlay bone graft fixated with a screw/ washer construct. Tibio-talo-calcaneal arthrodesis augmented by vascularized pedicled fibular graft, stabilized with retrograde compression intramedullary nail fixation, offers a reliable option for complex salvage situations when few other options exist.