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J Reconstr Microsurg 2002; 18(2): 091-096
DOI: 10.1055/s-2002-19888
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Valgus Deformity of the Ankle Following Harvesting of a Vascularized Fibular Graft in Children

K. Kanaya1 , T. Wada1 , H. Kura1 , T. Yamashita1 , M. Usui2 , S. Ishii1
  • 1Department of Orthopedic Surgery Sapporo >Medical University Sapporo, Japan
  • 2Orthopedic Clinic Higashi Hokkaido Hospital Kushiro, Japan
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Publication History

Publication Date:
31 January 2002 (online)

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ABSTRACT

Progressive valgus ankle deformity is a problematic postoperative donor-site morbidity of a vascularized fibular graft in children. To prevent this complication, tibiofibular metaphyseal synostosis (the Langenskiöld procedure) has been recommended. The authors objectively evaluated the preventive and therapeutic effects of this procedure on five children who had received free vascularized fibular grafts. Their average age at the time of operation was 3 years (range: 1 to 9 years). The Langenskiöld procedure was performed primarily in four patients, and not in one patient. The anteroposterior (A-P) mortise angle and the empirical axis of the donor-site ankle were measured radiographically. With regard to the A-P mortise angle, four of five patients showed valgus with a mild lateral wedging of the distal tibial epiphysis. The patient who did not receive the operation showed the largest A-P mortise angle and mild osteoarthritic changes. The empirical axis exceeded normal range in all of the five patients. These observations indicated that valgus deformity of the ankle in children after harvesting a vascularized fibular graft is inevitable, even if the Langenskiöld procedure is performed. The procedure can delay the ankle valgus. The authors recommend close follow-up of the children who receive the Langenskiöld procedure after harvesting a vascularized fibular graft.

KEYWORD

Vascularized fibular graft - valgus deformity - ankle - donor-site morbidity

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