A Simple Combination Frame for Postoperative Care of Free Flap Transfer in Foot and Ankle Reconstruction

Abstract

After microsurgical free flap transfer to the foot and ankle, an external fixator is often necessary to offload and protect the foot and the flap. Although modern circular ring fixators based on the original Ilizarov design are widely used, they are complex and time-consuming to construct. A combination frame consisting of an ordinary unilateral external fixator and a skeletal traction bow (Kirschner bow) was conceived at our institution. The unilateral external fixator is applied to the tibia and attached to a frame constructed with a kickstand to suspend the limb. To prevent equinus deformity, a skeletal traction bow is placed in the forefoot and fastened to the external fixator frame to complete the combination. The simplicity and ease of application reduce the surgical burden and time required after free flap transfer. Most trauma centers are equipped with the required components, a unilateral external fixator and skeletal traction bow. By uncoupling the two components, ankle movement exercises can be easily performed by rehabilitation staff. The results of free flap transfer to the foot and ankle with this hybrid frame were satisfactory. All flaps survived completely and all patients achieved plantigrade walking.