Ankle osteoarthritis: A rare complication after free fibular flap harvesting

SummaryFree fibular osteocutaneous flaps are used worldwide for mandibular defect reconstruction after tumor ablation of head and neck cancer. Although these flaps have generally been accepted as suitable sources of vascularized bone grafts, donor-site morbidity remains a concern. Ankle osteoarthritis (OA) is a rarely reported complication after free fibular flap harvesting. We report a case of rapidly progressed ankle OA after fibular flap harvesting and the experience in managing it. A 46-year-old obese woman was diagnosed to have floor of mouth cancer, T4aN1M0. After wide excision of the tumor, a 6.5 cm segmental mandibular defect was reconstructed using a free fibular osteocutaneous flap. The flap was harvested from the right leg, preserving 6.5 cm of the distal fibular bone. The patient was discharged 2 months later and could walk without assistance. Eight months after the patient was discharged, she complained of severe pain in the right ankle, especially while ambulating. Plain radiographs showed osteoarthritic changes in her right tibiotalar joint. Because of progressive debilitating pain, she underwent arthrodesis of the right ankle. After surgery, she was advised to lose weight, after which her clinical symptoms subsided. Tibiotalar OA is a rare complication after the harvesting of a free fibular flap. Morbid obesity may be a crucial factor predisposing patients to this complication. Arthrodesis and reduction of body weight could help patients return to daily activity and ambulation.