Repair of a lateral malleolus defect with a composite pedicled second metatarsal flap.

The patient was a 26-year-old man who fell while riding a motorcycle and friction led to defects in the lateral malleolus and soft tissue of the ankle. Although the wound surface healed with scarring and skin grafting, the patient had symptoms of ankle joint instability 4 months after the injury. Using a second metatarsal composite tissue flap with a dorsalis pedis artery pedicle, we repaired the soft tissue defect of the ankle and reconstructed the lateral malleolus. The head of the metatarsal bone was used to reconstruct the lateral malleolus and the flap was used to cover the wound surface. The distal fibula and metatarsus were completely healed 36 months postoperatively. The ankle had maintained stability at this time, with equal limb length and only a mild limitation of dorsal flexion in the ankle joint. The patient could walk, jog, and walk up and down stairs without limitations. There was no pain or limitation in activity at the donor site. Our findings suggest that the second metatarsal composite tissue flap with a dorsalis pedis artery pedicle is an effective option in reconstruction of the adult distal fibula.