A Case of Reconstruction by Vascularized Scapula Bone Flap for Infected Nonunion of Medial Malleolus after Open Fracture

Abstract

A 25-year-old man was injured in a single-car accident and diagnosed with traumatic subarachnoid hemorrhage, multiple right rib fractures, and open fracture of the right medial malleolus. Osteosynthesis of the open fracture of the right medial malleolus was performed at another hospital. However, it became infected postoperatively, and he was transferred to our hospital for curative treatment. First, the wound was debrided. The bone fragments of the medial malleolus had undergone osteolysis, and the remaining free-floating bone fragments were removed. There was a 14 × 6-cm soft tissue defect and a 4-cm osteochondral defect of the medial malleolus. After the signs of infection disappeared, reconstruction surgery was performed. A flap consisting of a 15 × 7-cm skin island and a 4 cm × 2-cm scapular flap were raised, and used to reconstruct the medial malleolus and cover the open wound. There were no signs of postoperative infection, and synostosis was achieved 3 months postoperatively. After 1 year, the patient was able to walk independently with no ankle instability and was able to return to work. The use of a vascularized scapular flap to reconstruct the medial malleolus was effective in preserving the ankle joint.