Pedicle and free vascularized bone transfers to the foot and ankle

Vascularized bone flaps provide an alternative option for complex foot and ankle problems. In the foot and ankle, large bone gaps can occur as result of avascular necrosis, trauma, or infection. In these situations, conventional bone grafting is not always successful leading to failed union. Vascularized bone is the ideal treatment for these scenarios. The fibula flap and the medial femoral condyle (MFC) flap are both good options for the foot and ankle. The MFC provides smaller portions of corticocancelous bone with a large periosteal covering. The fibula provides a large surface area of rigid cortical bone. We have successfully used these flaps for tibiotalar arthrodesis, pantalar arthrodesis, navicular revascularization, calcaneous nonunion, and persistent nonunion of the talus. The MFC is ideal when a small segment of vascularized bone is required, but when structural support is necessary, the fibula offers a larger cortical surface area providing more rigidity. Both flaps are valid options for foot and ankle reconstruction and salvage.