Long-Term Outcomes on Bone Growth Following Reconstruction of the Distal Fibula Using a Pedicled Second Metatarsal Osteomyocutaneous Flap in Children

At final follow-up after growth completion, no limb length discrepancy was observed. The ankle was stable, painless, and preserved good range of motion, with no significant donor site morbidity. This surgical technique represents a technically simpler alternative with lower morbidity compared with vascularized proximal fibular epiphyseal transfer for lateral malleolus reconstruction in growing children.