Conventional ankle arthrodesis yields unpredictable results when used in high-risk cases such as infection and after severe trauma. For high-risk distal limb salvage, the authors performed ankle arthrodesis using vascularized bone grafts. The study included three patients, aged 15, 22 and 61 years, and the disease etiology differed in each, being pyogenic arthritis, osteosarcoma in the distal tibia, and infection after Gustilo type IIIC open fracture, respectively. Donor sites were the scapula in the patient with pyogenic arthritis and the fibula in the other two. The graft was used for talocrural arthrodesis and preserving the subtalar joint, and an external fixator was applied in all cases. The graft included a skin flap for both soft tissue coverage and to monitor vascularity. All flaps survived and bony union was observed within 6 months after surgery. After removal of the external fixator, partial weight bearing was started. The patient with osteosarcoma developed local recurrence and above-knee amputation was performed 7 months after grafting. The other two patients regained walking ability and there was no recurrence of infection. Our study demonstrated that vascularized bone grafts can provide stable union between the tibia and talus, resulting in satisfactory function for intractable problems of the ankle.
