Free Vascularized Fibular Graft for Distal Tibial and Ankle Arthrodesis

The free vascularized fibular graft (FVFG) to the tibia was first described by Taylor et al in 1975.1 Since then, the operation has evolved to include transfer of adjacentmuscle, and in 1983 Chen andYandescribedanosteocutaneousflap.2These advancements have provided a limb-sparing option to those patients once destined for amputation. Indications for these procedures now include trauma, chronic osteomyelitis, wide resection of malignant tumor, and pseudoarthrosis of long bones.3 Prior to the advent of these procedures, complex fractures of the tibia were treated with autologous, nonvascularized cancellous bone grafting. Nonunion and complication rates were high, often leading to delayed amputation. Nonvascularized fibular autografts also showed high complication rates and particularly high rates of nonunion and stress fractures. Attempts to reduce these complications led to the proposal for vascularized grafts. Free vascularized flaps have quicker