The utilization of a perioperative muscle free flap in total ankle arthroplasty: A case report and brief review of the literature

Abstract

Ankle arthrodesis and total ankle arthroplasty (TAA) are both approaches to surgical treatment of ankle arthroses, with the latter becoming increasingly popular as it maintains ankle mobility. TAA has been associated with complications, including wound persistence, periprosthetic osteolysis, infection, and implant failure, which can be attributed to the area's poor vascularization and soft-tissue quality. In particular, the anterior compartment - solely supplied by the anterior tibial artery – explains the heightened risk of poor outcomes in ankle surgery. The effect of a secondary reconstructive procedure, such as a skin graft or a muscle flap for prosthesis salvage, has been well described in the literature. Muscle flaps are indicated in soft tissue reconstructive procedures because they provide a reliable blood supply and significant tissue volume where there is dead space. Here we outline a case where a 53-year-old male patient received a gracilis muscle free flap after TAA to improve outcomes and as an alternative orthoplastic procedure for patients who otherwise would undergo limb amputation. After several months of physical therapy, the patient is pain-free and active. With this, it can be concluded that a free muscle flap has the potential to be used perioperatively in higher-risk patients to improve TAA outcomes and as an alternative to other procedures that can reduce a patient's quality of life, such as ankle arthrodesis or amputation.