The role of free flaps for salvage of the exposed total ankle arthroplasty.

Abstract

Total ankle arthroplasty in the right circumstances cannot only relieve discomfort; but, unlike an ankle arthrodesis, can restore enhanced ambulatory capabilities. Subsequent wound healing issues have the potential to ultimately lead to implant removal, a disaster that can be avoided by as early intervention as possible that will provide sustainable wound closure. Over the past 5 years, 5 patients have presented in a delayed fashion with wound breakdown following total ankle arthroplasty that required a free flap for successful prosthesis salvage. The mean wound size was 78.0 cm² (range 14-200 cm² ). Two gracilis and 2 latissimus dorsi muscle free flaps were chosen as a malleable means not just to cover but to fill these usually large 3-dimensional wounds. A single radial forearm perforator free flap was selected in one case for a superficial wound that required a long vascular pedicle to reach outside the zone of injury. The postoperative course for all was uneventful, with a minimum follow-up of 4 months. Function preservation following total ankle arthroplasty wound breakdown even after an untimely delay in referral can still be maintained using microsurgical tissue transfers. © 2014 Wiley Periodicals, Inc. Microsurgery 37:34-37, 2017.