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Ankle Fusion in the Setting of Bone Loss
Ankle fusion in patients with substantial bone loss is a rarely performed and technically demanding procedure. Multiple situations may require fusion in the setting of bone loss. In these challenging situations, some of which may involve multiple revisions, infection, or substantial osteonecrosis, a large bone gap may make it difficult to achieve fusion using allograft alone. In these patients, a living bone flap vascularized from a donor vessel outside the zone of injury can be used to augment the arthrodesis. Conventional grafts heal by creeping substitution and often succumb to substantial resorption. In contrast, vascularized bone flaps result in the transfer of living osteocytes, which carry the potential for primary healing and typically do not resorb. Ultimately, this technique can lead to faster union and improved strength.