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Higgins JP. Vascularized Medial Femoral Condyle Flap Reconstruction for Osseous Defects of the Hand and Wrist. Hand Clin 2024; 40:151-159. [PMID: 37979987 DOI: 10.1016/j.hcl.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Vascularized bone flaps from the descending genicular artery system are versatile and effective for the use of recalcitrant nonunions from the tubular bones of the hand to the long bones of the upper extremity. Familiarity with the vascular pedicle, various techniques of harvest and inset, and skin paddle harvest and application are essential for the reconstructive surgeon.
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Affiliation(s)
- James P Higgins
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street, Johnston Professional Building, Mezzanine Level, Baltimore, MD 21218, USA.
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2
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di Summa PG, Sapino G, Wagner D, Maruccia M, Guillier D, Burger H. Combined Free Flaps for Optimal Orthoplastic Lower Limb Reconstruction: A Retrospective Series. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050859. [PMID: 37241091 DOI: 10.3390/medicina59050859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/10/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Open fracture of the lower limb can lead to substantial bone and soft tissue damage, resulting in a challenging reconstructive scenarios, especially in presence of bone or periosteal loss, with a relevant risk of non-union. This work analyzes outcomes of using a double approach for orthoplastic reconstruction, adopting the free medial condyle flap to solve the bone defects, associated to a second free flap for specific soft tissue coverage. Indications, outcomes and reconstructive rationales are discussed. Materials and Methods: A retrospective investigation was performed on patients who underwent complex two-flap microsurgical reconstruction from January 2018 to January 2022. Inclusion criteria in this study were the use of a free femoral condyle periostal/bone flap together with a second skin-only flap. Only distal third lower limb reconstructions were included in order to help equalize our findings. Out of the total number of patients, only patients with complete pre- and post-operative follow-up (minimum 6 months) data were included in the study. Results: Seven patients were included in the study, with a total of 14 free flaps. The average age was 49. Among comorbidities, four patients were smokers and none suffered from diabetes. Etiology of the defect was acute trauma in four cases and septic non-union in three cases. No major complications occurred, and all flaps healed uneventfully with complete bone union. Conclusions: Combining a bone periosteal FMC to a second skin free flap for tailored defect coverage allowed achievement of bone union in all patients, despite the lack of initial bone vascularization or chronic infection. FMC is confirmed to be a versatile flap for small-to-medium bone defects, especially considering its use as a periosteal-only flap, with minimal donor site morbidity. Choosing a second flap for coverage allows for a higher inset freedom and tailored reconstruction, finally enhancing orthoplastic success.
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Affiliation(s)
- Pietro G di Summa
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
| | - Gianluca Sapino
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
| | - Daniel Wagner
- Department of Orthopedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
| | - Michele Maruccia
- Department of Plastic Surgery and Reconstructive Surgery, University Hospital of Bari, 70100 Bari, Italy
| | - David Guillier
- Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery-University Hospital, 21231 Dijon, France
| | - Heinz Burger
- Privat Clinic Maria Hilf, 9010 Klagenfurt, Austria
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3
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The Medial Femoral Condyle Flap: A Novel Versatile Tool for Complex Microvascular Maxillofacial Reconstruction. Plast Reconstr Surg 2023; 151:115e-119e. [PMID: 36576826 DOI: 10.1097/prs.0000000000009779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
SUMMARY The medial femoral condyle flap is well-described for reconstruction of small bone defects of the upper and lower extremities. There are limited case reports of its use in other anatomic sites, particularly for reconstruction of complex head and neck defects. In the setting of previous radiation and contaminated fields, vascularized bone is generally preferred to bone grafts, cadaveric allografts, or synthetic implants. The authors present a case series of complex craniofacial defects involving the midface that were reconstructed using medial femoral condyle flaps, focusing on the type of defect and lessons learned from their early experience to promote awareness of this flap among microsurgeons, who may wish to consider the potential of this flap and incorporate its use into their armamentarium. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Golin AP, Zhang Z, Ratanshi I, McInnes CW. Acute Thumb Reconstruction With Medial Femoral Condyle and Radial Forearm Free Flaps: A Case Report. Hand (N Y) 2022; 18:NP1-NP6. [PMID: 35668636 PMCID: PMC10152520 DOI: 10.1177/15589447221096705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traumatic thumb injuries often result in significant functional disability. With segmental bone loss, reconstructive options include antibiotic cement with delayed bone graft, revision amputation with webspace deepening, metacarpal distraction osteogenesis, index pollicization, bone flap, and free toe transfer. We present a case of a subtotal thumb amputation just distal to the metacarpal phalangeal joint resulting in loss of both soft tissue and a segmental bone defect of the proximal and distal phalanx. Reconstruction was initially performed with a chimeric bone free flap from the medial femoral condyle with a vastus medialis muscle cuff to provide soft tissue coverage. A revision soft tissue coverage procedure was required and a radial forearm free flap was utilized. His reconstruction restored his missing bone and soft tissue, and provided stability with sufficient grip strength and metacarpophalangeal function resulting in a satisfactory functional outcome.
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Affiliation(s)
- Andrew P Golin
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Zach Zhang
- Division of Plastic Surgery, University of British Columbia, Vancouver, Canada
| | - Imran Ratanshi
- Division of Plastic Surgery, University of British Columbia, Vancouver, Canada.,Royal Columbian Hospital, Fraser Health Authority, British Columbia, Canada
| | - Colin W McInnes
- Division of Plastic Surgery, University of British Columbia, Vancouver, Canada.,Royal Columbian Hospital, Fraser Health Authority, British Columbia, Canada
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Poelsler L, Koch O, Gaggl A, Presl J, Hutter J, Brandtner C, Emmanuel K. Microvascular myocutaneous and cutaneous free flap reconstruction in patients with terminal esophagostomy after complicated oncological esophagus resection. Eur Surg 2021. [DOI: 10.1007/s10353-021-00744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Summary
Background
Persisting anastomotic leakage after oncological esophagectomy is a severe problem associated with high mortality and morbidity. Unfortunately, treatment options with promising results are scarce, especially when conventional operative and endoscopic methods have failed. Due to limitation of oral intake and the need for artificial nutrition, quality of life (QOL) is reduced. Microvascular myocutaneous and cutaneous free flap (MFF) reconstruction could be a promising alternative.
Methods
This retrospective case series presents 7 patients treated between March 2017 and November 2020 at our surgical department, with persisting postoperative anastomotic leakage without further feasible treatment options. All patients received anastomotic MFF reconstruction; used flaps and important intraoperative factors like microvascular anastomosis were evaluated. Complications and patient contentment was assessed.
Results
The included 7 male patients had median age of 65.15 years (range: 48–75). MFF function was adequate in 6/7 patients, one flap necrosis was encountered. Whereas 5 patients initially had good results, surgical revision was performed in 1 patient to ensure graft function. Postoperative complications appeared in 6/7 patients. Mean duration of inpatient care was 63 days (range: 24–156). At the time of evaluation, 1 patient has died of his malignant disease. No more additional nutrition was needed in 3/6 patients with adequate graft function. Most patients reported improved QOL after MFF.
Conclusion
MFF free flap can be an alternative treatment option for patients with terminal esophagostomy after complicated oncological esophagus resection without further treatment options. The renewed ability of oral food intake results in a significant improvement of QOL.
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Neuwirth M, Ziegler T, Benedikt S, Winter R, Kamolz LP, Schintler M, Rab M, Mueller-Eggenberger M, Mischitz M, Palle W, Hoenck K, Schoellnast H, Janek E, Borenich A, Buerger H. Donor site morbidity after the harvest of microvascular flaps from the medial and lateral femoral condyle region: Objective, radiologic, and patient-reported outcome of a multi-center trial. J Plast Reconstr Aesthet Surg 2021; 75:160-172. [PMID: 34635456 DOI: 10.1016/j.bjps.2021.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/27/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND With the experience-based hypothesis of low donor site morbidity (DSM) for free flaps from the distal femur, this cohort study aimed to evaluate the DSM according to objective and reproducible criteria. METHODS One hundred and fifty-six patients who had a flap harvest from either the medial or lateral femoral condyle region between 2005 and 2017 were included. A retrospective chart review was performed for all patients. In total, 97 patients were available for a follow-up examination. Outcomes were assessed according to objective (Knee Society Score; Larson Knee Score; OAK Score; 0-100 points), patient-reported (IKDC Score; KOOS Score; 0-100 points), and radiologic criteria (Kellgren and Lawrence Score; MRI Osteoarthritis Knee Score). RESULTS The median follow-up time was 1,529 days (range: 248-4,810). The mean Knee Society Score (94.8 ± 10.1), Larson Knee Score (94.5 ± 10.1), and OAK Score (95.5 ± 6.6) showed nearly unimpaired knee function. The overall patient-reported DSM was low (IKDC Score: 86.7 ± 17.4; KOOS Score: 89.3 ± 17.1). Osteochondral (OC) flaps had a significantly higher DSM, regardless of the donor site. Bone flaps did not show any relevant radiologic morbidity in the Kellgren and Lawrence Score. Besides the procedure-associated cartilage lesions at the OC donor sites, MRI Osteoarthritis Knee Score did not show any significant presence of further knee pathologies in the bilateral MRI Scans. The obvious cartilage lesions did not have a relevant impact on the knee function of most patients. CONCLUSION The DSM for bone and soft-tissue flaps from the femoral condyle region is negligible. OC flaps are associated with a significantly higher DSM, although a clinically relevant impact on knee function was not evident in the majority of patients.
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Affiliation(s)
- Maximilian Neuwirth
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria; Departement of Plastic, Aesthetic and Reconstructive Surgery, General Hospital Klagenfurt am Woerthersee, Feschnigstraße 11, Klagenfurt 9020, Austria.
| | - Thomas Ziegler
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - Stefan Benedikt
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - Raimund Winter
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - Lars P Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - Michael Schintler
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - Matthias Rab
- Departement of Plastic, Aesthetic and Reconstructive Surgery, General Hospital Klagenfurt am Woerthersee, Feschnigstraße 11, Klagenfurt 9020, Austria
| | - Michael Mueller-Eggenberger
- Departement of Plastic, Aesthetic and Reconstructive Surgery, General Hospital Klagenfurt am Woerthersee, Feschnigstraße 11, Klagenfurt 9020, Austria
| | - Madeleine Mischitz
- Departement of Plastic, Aesthetic and Reconstructive Surgery, General Hospital Klagenfurt am Woerthersee, Feschnigstraße 11, Klagenfurt 9020, Austria
| | - Wolfgang Palle
- Department of Trauma Surgery, Hospital Friesach, Austria
| | - Karina Hoenck
- Department of Trauma Surgery, Hospital Friesach, Austria
| | - Helmut Schoellnast
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria
| | - Elmar Janek
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria
| | - Andrea Borenich
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Heinz Buerger
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria; Departement of Plastic, Aesthetic and Reconstructive Surgery, General Hospital Klagenfurt am Woerthersee, Feschnigstraße 11, Klagenfurt 9020, Austria; Division of Hand and Microsurgery, Private Hospital Maria Hilf, Austria
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Fonkoue L, Behets C, Steyaert A, Kouassi JEK, Detrembleur C, Cornu O. Anatomical study of the descending genicular artery and implications for image-guided interventions for knee pain. Clin Anat 2020; 34:634-643. [PMID: 32920906 DOI: 10.1002/ca.23680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/11/2020] [Accepted: 09/05/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The descending genicular artery (DGA) has recently been mentioned as accompanying some nerves in the medial aspect of the knee joint. This could be clinically relevant as the arteries could serve as landmarks for accurate nerve capture during ultrasound-guided nerve blockade or ablation. The aim of this cadaveric study was to investigate the anatomical distribution of the DGA, assess the nerves running alongside its branches, and discuss the implications for regional anesthesia and knee pain interventions. METHODS We dissected the femoral artery (FA) all along its course to identify the origin of the DGA, from which we carefully dissected all branches, in 27 fresh-frozen human specimens. Simultaneously, we systematically dissected the nerves supplying the medial aspect of the knee from proximally to distally and identified those running alongside the branches of the DGA. The surrounding anatomical landmarks were identified and measurements were recorded. RESULTS The DGA was found in all specimens, arising from the FA 130.5 ± 17.5 mm (mean ± SD) proximally to the knee joint line. Seven distribution patterns of the DGA were observed. We found three consistent branches from the DGA running alongside their corresponding nerves at the level of the medial aspect of the knee: the artery of the superior-medial genicular nerve, the artery of the infrapatellar branch of the saphenous nerve, and the saphenous branch of the DGA. CONCLUSION The consistent arteries and surrounding landmarks found in this study could help to improve the capture of the targeted nerves during ultrasound-guided interventions.
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Affiliation(s)
- Loïc Fonkoue
- Department of Morphology - Experimental and Clinical Research Institute (IREC), UCLouvain, Brussels, Belgium.,Neuro-Musculo-Skeletal Department (NMSK)-IREC, UCLouvain, Brussels, Belgium
| | - Catherine Behets
- Department of Morphology - Experimental and Clinical Research Institute (IREC), UCLouvain, Brussels, Belgium
| | - Arnaud Steyaert
- Department of Anesthesia and Pain Medicine, UCLouvain, Brussels, Belgium.,Institute of Neuroscience (IONS), UCLouvain, Brussels, Belgium
| | | | | | - Olivier Cornu
- Neuro-Musculo-Skeletal Department (NMSK)-IREC, UCLouvain, Brussels, Belgium.,Department of Orthopedics and Trauma, University Hospital St-Luc, Brussels, Belgium
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8
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Augmented Reality-Assisted Periosteum Pedicled Flap Harvesting for Head and Neck Reconstruction: An Anatomical and Clinical Viability Study of a Galeo-Pericranial Flap. J Clin Med 2020; 9:jcm9072211. [PMID: 32668591 PMCID: PMC7408700 DOI: 10.3390/jcm9072211] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/29/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022] Open
Abstract
Head and neck reconstructive surgeons have recently explored new perspectives in bone restoration using periosteum carrier flaps. Following this idea, we explored the possibility of harvesting a galeo-pericranial flap. The present work studies the vascular supply of the pericranial temporo-parietal region in order to assess the possibility of harvesting a galeo-pericranial flap based on the superficial temporalis vascularization. Anatomical dissections were performed at the Anatomical Institute of the University of Bologna on eight donor cadavers. Then we performed the harvesting of the flap in vivo on eight patients. We introduced augmented reality (AR) to facilitate anatomical visualisation during free flap harvesting. Augmented reality merges virtual and actual objects, allowing direct observation of patient anatomy and the surgical field. No post-operative major or minor complications occurred. We encountered no post-operative functional issues on the donor or recipient sites, and good clinical healing was observed in all patients. In conclusion, we believe that the galea-pericranium flap could represent a new donor site for the harvesting of a periosteum carrier flap.
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9
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Quintero JI, Childs D, Moreno R. The medial femoral condyle free flap: An excellent option for difficult cases: case series. SAGE Open Med Case Rep 2020; 8:2050313X20933763. [PMID: 32647579 PMCID: PMC7325544 DOI: 10.1177/2050313x20933763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 05/20/2020] [Indexed: 11/17/2022] Open
Abstract
The use of the medial femoral condyle free flap is a versatile option for the treatment of upper extremity non unions and reconstructive procedures associated with bone loss or osteonecrosis. The benefit of this type of flap is the viability of the bone which favors primary ossification and increases bone density. Vascularized free bone flaps are especially useful for the treatment of recalcitrant nonunions, or nonunions that have failed three or more treatments to obtain consolidation. We present a case series of three patients treated with medial femoral condyle free flap for reconstruction of the upper extremity of different etiologies at the level of the distal humerus, distal radius and distal phalanx of the thumb.
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Affiliation(s)
- Jorge I Quintero
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA.,Division of Hand Surgery, Department of Surgery, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Dylan Childs
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA.,Division of Hand Surgery, Department of Surgery, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Rodrigo Moreno
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA.,Division of Hand Surgery, Department of Surgery, School of Medicine, University of Louisville, Louisville, KY, USA
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10
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Nicholls AJ, Hargreaves I, Wheen D. Vascularized medial femoral condyle flap harvest adjacent to total knee arthroplasty: a case report. J Hand Surg Eur Vol 2020; 45:202-204. [PMID: 31795811 DOI: 10.1177/1753193419889299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Alexander J Nicholls
- St Luke's Hand Unit, St Luke's Private Hospital, NSW, Australia.,Department of Orthopaedics, Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | - Ian Hargreaves
- St Luke's Hand Unit, St Luke's Private Hospital, NSW, Australia
| | - Douglass Wheen
- St Luke's Hand Unit, St Luke's Private Hospital, NSW, Australia
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11
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Medial femoral condyle free flap for head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2019; 27:130-135. [DOI: 10.1097/moo.0000000000000517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Xu Q, Zheng X, Li Y, Zhu L, Ding Z. Anatomical Study of the Descending Genicular Artery Chimeric Flaps. J INVEST SURG 2019; 33:422-427. [PMID: 30884993 DOI: 10.1080/08941939.2018.1532541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Qingjia Xu
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Xuefeng Zheng
- Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, Guangzhou, China
| | - Yang Li
- Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, Guangzhou, China
| | - Lei Zhu
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zihai Ding
- Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, Guangzhou, China
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13
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Grohmann M, Benedikt S, Vasilyeva A, Bürger H, Forbes A, Schintler MV. An Innovative Application of the Free Vascularized Medial Femoral Condyle Flap in the Prevention of Recurring Neuropathic Ulcer in the Diabetic Foot: A Case Report. J Foot Ankle Surg 2019; 57:1020-1023. [PMID: 29804922 DOI: 10.1053/j.jfas.2018.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Indexed: 02/03/2023]
Abstract
Despite various therapy options, the prophylactic and symptomatic treatment of recurrent ulcerations in the diabetic foot are still challenging. We report the application of a free vascularized medial femoral condyle flap to prevent the recurrence of pressure ulcer in a patient with diabetic foot syndrome. Our patient had type 2 diabetes and presented with pressure ulcers and osteomyelitis of metatarsal heads 2 and 3 after a great toe amputation. We chose to use a medial femoral condyle flap as a damper in the area of the metatarsal heads because of the relatively young age and good vascularity of our patient. We shaped the graft like a ski to distribute the pressure and prevent perforation of the plantar skin. Good results were achieved for wound healing, pain reduction, and improvement of gait. No pressure ulceration had recurred after a 3-year follow-up period. The versatility of the osteomyocutaneous graft from the medial femoral condyle is an important reconstructive tool for addressing major surgical problems. We present the first use of a medial femoral condyle flap in the treatment of a pressure ulcer in a diabetic foot. In selected patients, our method could prevent premature and extended amputations, thereby providing good improvement in patients' quality of life.
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Affiliation(s)
- Martin Grohmann
- Medical Doctor, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Stefan Benedikt
- Medical Doctor, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - Anna Vasilyeva
- Medical Doctor, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Heinz Bürger
- Medical Doctor, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Abigail Forbes
- Medical Doctor, Plastic Surgery, University of Texas Medical Branch, Galveston, TX
| | - Michael Valentin Schintler
- Professor, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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14
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Hong JP(J, Song S, Suh HSP. Supermicrosurgery: Principles and applications. J Surg Oncol 2018; 118:832-839. [DOI: 10.1002/jso.25243] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/23/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Joon Pio (Jp) Hong
- Department of Plastic SurgeryAsan Medical Center, University of Ulsan College of MedicineSeoul Korea
| | - Sinyoung Song
- Department of Plastic SurgeryAsan Medical Center, University of Ulsan College of MedicineSeoul Korea
| | - Hyun Suk Peter Suh
- Department of Plastic SurgeryAsan Medical Center, University of Ulsan College of MedicineSeoul Korea
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15
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Hsu CC, Tseng J, Lin YT. Chimeric Medial Femoral Condyle Osteocutaneous Flap for Reconstruction of Multiple Metacarpal Defects. J Hand Surg Am 2018; 43:781.e1-781.e9. [PMID: 29735291 DOI: 10.1016/j.jhsa.2018.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 03/17/2018] [Indexed: 02/02/2023]
Abstract
When faced with reconstructing metacarpal defects, various options have been described. We describe a chimeric medial femoral condyle osteocutaneous flap as a new method for providing multiple bone grafts as well as soft tissue coverage in a single stage. The medial femoral condyle has become an area of increased interest given the versatility it allows in harvesting the bone. This osteocutaneous flap is useful when reconstructing small- to medium-sized adjacent metacarpal bone defects. The chimeric design of the flap lends flexibility at the time of inset that is absent for other options of vascularized bone grafts. The ease of harvest, straightforward anatomy, flexibility at inset, and limited donor site morbidity make this flap an effective option when treating such injuries.
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Affiliation(s)
- Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan.
| | - James Tseng
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan
| | - Yu-Te Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan
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16
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Descending genicular artery. Branching patterns and measuring parameters: A systematic review and meta-analysis of several anatomical studies. J Plast Reconstr Aesthet Surg 2018; 71:967-975. [PMID: 29655665 DOI: 10.1016/j.bjps.2018.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 02/15/2018] [Accepted: 03/10/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The medial femoral condyle (MFC) flap is based on the descending genicular artery (DGA), which is a vessel with different variations in its course and branching patterns. Many studies have dealt with the vascular anatomy of the MFC. However, the results of the investigations differ markedly. METHODS The authors performed a systematic literature search in MEDLINE for articles published until May 2017 on the vascular anatomy of the DGA. After the screening, 23 relevant studies with a similar topic were included into this comprehensive analysis. RESULTS The systematic review examined the lengths and diameters of the individual arteries with regard to the vascularized bone flap of the MFC. The DGA is present in 94% of cases with an average length of 1.8 cm. In 63% of the investigated cases, the DGA divides into three terminal branches. The articular branch has an average length of 7.7 cm, the saphenous branch has a length of 10.7 cm, and the muscular branch has a length of 3.2 cm. CONCLUSION To ensure a secured survival of this free flap, a detailed understanding of the convoluted vascular anatomy above the MFC is necessary. We recommend the Dubois classification for a systematic classification of the anatomical patterns of the DGA.We present a summary of all anatomical studies dealing with the vascular supply to the MFC and the DGA to date.
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Kwon HH, Lee WY, Choi SC, Jung JY, Bae Y, Park GH. Combined treatment for skin laxity of the aging face with monopolar radiofrequency and intense focused ultrasound in Korean subjects. J COSMET LASER THER 2018; 20:449-453. [PMID: 29469595 DOI: 10.1080/14764172.2018.1427870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although various minimal invasive approaches are available for aging skin laxity, they alone may not lead to notably satisfactory results. OBJECTIVE To evaluate the effectiveness and safety of combination regimen with monopolar radiofrequency (MRF) and intense-focused ultrasound (IFUS) in facial lifting and tightening. METHODS Twenty-two Korean participants with aging face received a sequential single session of MRF and IFUS treatment. Objective and subjective assessments for improvement were performed at the 20-week post-treatment. Safety profiles were also recorded, and skin biopsies were taken at baseline and follow-up visit. RESULTS Based on the objective assessment for the overall facial skin tightening and laxity, 19 patients (90%) demonstrated "moderate" or better improvements (more than 25%) compared with baseline. Specifically, improvements of skin laxity and sagging, and droopy jaw line were more noticeable compared with that of superficial skin texture (P < 0.05). Subjective satisfactions were generally consistent with objective findings, and no serious adverse effect was observed. Histologic evaluation showed increased dermal collagen fibers throughout the dermis after treatments (P < 0.05). CONCLUSION Combination treatment of MRF and IFUS has cumulative benefits for skin lifting and tightening with satisfactory safety profiles in Asian subjects.
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Affiliation(s)
| | - Won-Yong Lee
- b Seoul Institute of Clinical Cosmetology , Seoul , Korea
| | | | | | - Youin Bae
- c Department of Dermatology, Dongtan Sacred Heart Hospital , Hallym University College of Medicine , Hwaseong , Korea
| | - Gyeong-Hun Park
- c Department of Dermatology, Dongtan Sacred Heart Hospital , Hallym University College of Medicine , Hwaseong , Korea
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Kwon HH, Choi SC, Park KH, Jung JY. A novel combination regimen with intense focused ultrasound and pressure- and dose-controlled transcutaneous pneumatic injection of hypertonic glucose solution for lifting and tightening of the aging face. J Cosmet Dermatol 2017; 17:373-379. [PMID: 29024489 DOI: 10.1111/jocd.12419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Intense focused ultrasound (IFUS) has demonstrated moderate efficacy for facial laxity of the aging face. Pressure- and dose-controlled transcutaneous pneumatic injections of hypertonic glucose solution (TPIG) are a minimally invasive way to deliver solution into the skin for therapeutic purposes. Recently, its application around temporal areas is known to exert early-onset lifting effects with facial contour rejuvenation. AIMS We sought to evaluate the safety and efficacy of this novel combination regimen with IFUS and TPIG for lifting and tightening of aging face. PATIENTS AND METHODS Twenty-two Korean subjects with mild-to-moderate facial skin laxity were evaluated after receiving a sequential single session of IFUS and TPIG treatments. Dermatologists' objective assessments for general appearance, and mid- and low faces based on photographic images were performed at 1- and 12-week post-treatment follow-ups. Patients' subjective assessments were also conducted. Skin biopsies were taken at baseline and the last visit. RESULTS Among 22 subjects, twenty (91%) demonstrated improvement after 12-week follow-up. We also observed similarly improved state just after 1 week of treatments (82%: 18/22). Specifically, improvement of the mid-face was evident from the first week, while the progress of the low face improvement was observed at the twelve week. Subjective assessments paralleled these findings. No seriously adverse effect was observed during procedures. Histologic evaluation showed greater dermal collagen fibers throughout the dermis after treatments. CONCLUSION Combination treatment with IFUS and TPIG has beneficial effects for skin lifting and tightening with early-onset time.
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Affiliation(s)
| | | | - Kyung-Hoon Park
- Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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