Reconstruction Using an Osteofasciocutaneous Fibula Free Flap for a Distal Tibial Defect in Refractory Chronic Osteomyelitis: A Case Report

The fibular free flap (FFF) is an option used for tibial defect reconstruction in post-traumatic chronic osteomyelitis (PCOM). However, as the tibia is a weight-bearing bone, there exists a risk of compression fracture risk after FFF. This complicates reconstructing distal tibial defects adjacent to the articular cartilage. We report a successful case of reconstruction using FFF for a bone defect adjacent to the distal tibial articular surface in refractory PCOM. The patient was a 73-year-old woman with refractory PCOM in the right distal tibia secondary to a tibial fracture from a traffic accident that occurred 28 years ago. After bone debridement, the tibial bone defect was 8 cm in length, and its distal margin was located 0.5 cm above the articular surface of the tibiotalar joint. Tibial bone and soft tissue defects were reconstructed using a contralateral FFF consisting of an 8-cm fibula bone and a 14×5-cm-sized skin paddle. After 2 months, an Ilizarov apparatus was applied and maintained for 3 months. After 6 months, she started weight-bearing. The follow-up period was 15 months. Imaging studies revealed bone block union. The patient displayed no difficulty in ambulation and had no additional infections or flap necrosis.