Syed Asif Shah, Muhammad Bilal, Irfanullah, Mohammad Hamayun Shiwari, Adeeba Ahmad, Tahira Yasmeen.
An early experience of reconstruction of foot tripod with free fibula flap.
Pak J Surg Jan ;36(1):59-65.

Objectives: To evaluate the role of vascularised free fibula osteocutaneous flap for reconstruction of first metatarsal bone. Study design: Experimental Study Sett ing: Plastic Surgery unit, Hayatabad Medical Complex, Peshawar from March 2015 to February 2018. Subjects: Five male patients between the ages 24-44 years. Material and Methods: This experimental study was conducted at the Plastic Surgery Unit, Hayatabad Medical Complex, Peshawar from March 2015 to February 2018. A total of 5-male patients underwent reconstruction of complex fore-foot defects involving the metatarsal bone and overlying soft tissues. All the defects were traumatic in nature. Vascularized free fibula oseteocutaneous flap was use to reconstruct the complex defects of foot involving the metatarsal bone. Results: Th ere were 5-male adult patients with post-traumatic defects of the fore-foot. Th e age of the patients ranged from 24-44 years and the mean age was 32-years. Th e indications for the reconstruction were damage to the fi rst metatarsal bone which is an essential component of foot tripod. Initially wound debridement was done and delayed reconstruction of the metatarsal bone was performed with free fi bula osteocutaneous fl ap. All the fl aps survived completely. Problems of delayed wound healing, graft loss at donor site, donor site scarring, paresthesia in the foot were observed in few patients. All the patients were ambulant and started walking at 12th week post-operatively. Conclusions: Free fibula osteocutaneous flap is an ideal option for reconstruction of complex defects of the fore-foot. The advantage of fibula is its adequate length and bone density which resembles the morphology of metatarsals. Th e fl ap has fewer complications and produce better structural and functional outcomes.

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