FIG. 15-56. The vascularized iliac graft and overlying skin island are shown next to the donor area in the hip.

FIG. 15-57. The osteocutaneous flap is next to the ankle defect. The superficial circumflex iliac system to the skin flap is seen at the upper corner. The deep circumflex iliac vessels supplying the bone are not shown, but are under the flap. The anterior tibial vessels have been isolated and the recipient bony defect cleaned out. The proximal portion of the iliac graft will go into the proximal medullary cavity of the tibia and the lower portion will go across the ankle joint.

FIG. 15-58. The postoperative x ray shows the graft in place, stabilized with a large K-wire.

FIG. 15-59. The skin flap is shown sutured in place over the anterior surface the ankle joint.

FIG. 15-60. Lateral postoperative x ray shows fusion of the ankle.

FIG. 15-61. In an AP view of the same area, the intermedullary portion of the graft is well visualized.

FIG. 15-62. An early postoperative technetium scan at one week shows graft to light up well.

FIG. 15-63. Late follow-up of the skin flap and ankle shows adequate soft-tissue protective cover.

CASE 8

This patient had a soft-tissue and bony defect of the right heel with loss of most of the calcaneus and the weight-bearing surface of the heel. Restoration of bony contour and a sensory cutaneous flap was needed. The patient was relatively thin, and the osteocutaneous iliac crest graft using the sensory input from T-12 was selected.

FIG. 15-64. The pattern of the contemplated defect is shown next to the bony skin loss.

FIG. 15-65. The osteocutaneous flap is shown next to the donor defect.

FIG. 15-66. Flap next to excisional defect.

FIG. 15-67. The osteocutaneous flap is in place. The branches of T-12 entering the base of the flap were anastomosed to terminal branches of the deep peroneal, which was mobilized and rotated down to the inner surface of the ankle.

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