Utilization of the Free Fibular Flap for First Metatarsal Reconstruction

Abstract

Summary: Beyond being aesthetically unpleasing, metatarsal defects have been known to lead to several patient concerns such as intermetatarsal malpositioning and metatarsalgia. There are several reconstructive techniques that have been utilized for reconstruction of bony defects in the foot, including the free dorsal toe flap and dorsal metatarsal perforator flap. Our institution has utilized the free fibular flap for surgical management pertaining to tarsal reconstruction. Our study looks to evaluate the work of a single plastic surgeon and identify patient postoperative outcomes. A retrospective chart review was conducted at Beaumont Health System, Royal Oak for patients who underwent first metatarsal reconstruction with a free fibular flap between the years 2015 and 2022. Demographic data, operative details, complications, medical comorbidities, and patient outcomes were retrospectively gathered and analyzed. A total of two patients were isolated after chart review. Both patients were found to have tolerated the procedure well and had no intraoperative complications. In addition, all patients had clinically viable flaps and were satisfied with their surgical results. The free fibular flap may be used effectively in the management of metatarsal defects that have failed prior therapy. In our study, both patients who underwent surgical management with a free fibular flap were noted to have successful long-term results. With the right expertise and patient population, a free fibular flap can be highly successful in the repair of metatarsal defects.

Functional Reconstruction of Arches of the Foot With Vascularized Fibula Flap

“…Although several case reports are presented about foot reconstruction, none of them mentioned reconstruction of the arches and evaluated its importance on gait parameters. 15,17,27 Here, our 3-dimensional gait analysis results showed that acceptable foot arch reconstruction is achievable using free vascularized fibula flap. Dynamic podography revealed similar pressure distribution with the uninjured foot, without any increased pressure areas.…”

“…Despite this importance, the arches of the foot are generally underestimated during the foot reconstruction. Although several case reports are presented about foot reconstruction, none of them mentioned reconstruction of the arches and evaluated its importance on gait parameters 15,17,27 . Here, our 3-dimensional gait analysis results showed that acceptable foot arch reconstruction is achievable using free vascularized fibula flap.…”

“…3,4,25 Among them, fibula is now well-recognized source of vascularized bone and has important advan-tages over other donor sites. 18,26,27 It is composed of primarily of cortical bone and able to withstand and adapt to the stress of weight bearing. In accordance with the literature, our experience showed that free fibular flap is a versatile option for reconstruction of composite defects of the foot and provides durable coverage and support.…”

“…In the literature, there are few reports about the reconstruction of the longitudinal arch of the foot. 3,15,16,18,27 Roll et al 3 used osteocutaneous parascapular flap for reconstruction of first ray. In his series, metatarsophalangeal (MP) joint was preserved in all cases so a parascapular flap was used for intercalated defects of the first metatarsal bone.…”

“…Several osteocutaneous flaps may be considered to reconstruct bony defects of the foot, including fibular, iliac, and scapular flaps 3,4,25 . Among them, fibula is now well-recognized source of vascularized bone and has important advantages over other donor sites 18,26,27 . It is composed of primarily of cortical bone and able to withstand and adapt to the stress of weight bearing.…”