Obesity in general is a predisposing factor

Obesity in general is a predisposing factor of OA. There is a strong association between overweight and hip and knee OA. However, the association between overweight and ankle OA remains unclear. In Frey and Zamora\'s study regarding overweight and ankle OA, a total of 887 women and 535 men were included, and the results showed that being overweight may increase the likelihood of ankle OA. However, this association was not statistically significant. Another study systemically reviewed 25 papers concerning the association between BMI and musculoskeletal foot disorders. The authors concluded that there is a strong association between increased BMI and nonspecific foot pain and chronic plantar heel pain; however, evidence is inconclusive regarding the relationship between BMI and foot OA. Some studies suggested that misalignment was the main cause of OA in obese patients. In our case study, ankle instability after fibular flap harvesting may have contributed to the misalignment of the ankle weight-bearing system. In addition to the patient\'s morbid obesity, misalignment could be the mechanism that led to the development of ankle OA. The overall incidence of ankle arthritis is nine times lower than that of hip or knee arthritis. In cases where conservative treatment of severe ankle OA has failed, arthrodesis is an effective method for reducing ankle pain and enabling the patient to ambulate early. Although alternatives such as joint-sparing procedures and total ankle replacement remain a relevant issue, arthrodesis is still the current standard method for managing end-stage ankle arthritis. Ankle arthrodesis is a surgical procedure that yields reliable healing, relieves pain, and enables increased activity. A study reported that ankles treated with total ankle replacement had greater function and equivalent pain relief compared with those treated with arthrodesis. In our case, arthrodesis was a reasonable choice for treating ankle OA because of the patient\'s morbid obesity and history of fibular bone harvesting. After arthrodesis, the patient achieved a positive functional outcome and could ambulate well without pain. Substantial cetrimonium bromide of her body weight also improved the final outcome.
Conclusion
Introduction Reconstruction of soft-tissue defects around the knee remains a challenge. The main goals of soft-tissue reconstruction around the knee area are to restore the contour of the knee and to preserve knee function. Large soft-tissue defects with underlying tendon, bone, or even bone fixation implant exposure are not uncommon during soft-tissue reconstruction in the knee area. Because of the limited choice of local cutaneous and muscle flap options in this area, free-tissue transfer is often required. However, the choice of recipient vessels around the knee area is limited. The reverse-flow anterolateral thigh (ALT) flap was first described by Zhang in 1990. Pan et al conducted an anatomic study of the reverse-flow ALT flap in 2004. They found that every 10 of 11 patients have type I or type III perforators according to Shieh et al\'s classification of ALT perforators, meaning that most of the perforators are derived from the descending branch of the lateral circumflex femoral artery; thus, the reverse-flow ALT flap is an easily accessible flap to harvest. Limited data are available on reverse-flow ALT flap for knee area reconstruction. In this study, we present our experience regarding soft-tissue reconstruction around the knee area by using reverse-flow ALT flap without antegrade venous supercharge.
Materials and methods
Results All of the defects were initially reconstructed by using reverse-flow ALT flap (Table 1). The sizes of the flaps ranged from 12 cm × 6 cm to 20 cm × 10 cm (average, 140 cm2), and the donor sites were primarily closed. The lengths of the pedicles ranged from 8 cm to 16 cm (average, 12.8 cm). The pivot points of the flaps were 5–13 cm (average, 7.75 cm) proximal to the upper margin of the patella. Although the procedures for the flap transfer were uneventful, various degrees of venous congestion occurred after the operation. The period of congestion was 3–7 days (average, 4.5 days). Two flaps had venous congestion for 3 days and survived completely. Flaps measuring 20 cm × 10 cm had venous congestion for 5 days and, therefore, necrotized (4 cm × 8 cm). A local rotational flap was used for wound closure. Another flap measuring 22 cm × 8 cm had venous congestion for 7 days, and, therefore, more than two-thirds of it necrotized; the wound was closed using a split-thickness skin graft.