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Mehta MP, Butler BA, Lanier ST, Ko JH, Kadakia AR. Calcaneal Reconstruction With Femoral Head Allograft Vascularized by an Osteocutaneous Medial Femoral Condyle Flap: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00007. [PMID: 34648468 DOI: 10.2106/jbjs.cc.21.00188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 25-year-old man presented with a closed calcaneal fracture after a 6-storey fall, complicated by osteomyelitis from fixation attempts necessitating near-complete debridement of his calcaneal tuberosity. He underwent a successful single-stage calcaneal and soft-tissue reconstruction using a femoral head structural allograft vascularized with an osteocutaneous medial femoral condyle flap. At the 18-month follow-up, his limb is largely pain-free and functional, allowing ambulation and his combined allograft-vascularized bone reconstruction shows radiographic evidence of incorporation. CONCLUSION Calcaneal tuberosity reconstruction with a femoral head structural allograft and vascularized bone flap is a viable option for calcaneal tuberosity bone loss because of injury/infection.
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Affiliation(s)
- Manish P Mehta
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bennet A Butler
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Steven T Lanier
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jason H Ko
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anish R Kadakia
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Xiao H, Wang S, Wang F, Dong S, Shen J, Xie Z. Locking Compression Plate as an External Fixator for the Treatment of Tibia Infected Bone Defects. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021. [PMID: 34496424 DOI: 10.1055/a-1545-5363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This study was designed to observe the medium-term efficacy of an induced membrane technique combined with a locking compression plate as an external fixator for the treatment of tibia infected bone defects. METHODS Patients with a tibial infection were admitted to our department between January 2013 and November 2014. All patients were treated with the induced membrane technique. In the first stage, polymethyl methacrylate (PMMA) cement was implanted in the defects after debridement and then fixed with a locking compression plate (LCP) as an external fixator. In the second stage, bone grafts were implanted to rebuild the defects. The external plates were replaced with nails in 57 patients (internal group), and the remaining 30 patients were not exchanged with fixation (external group). The infection control rate, bone union rate, and complications of the two groups were compared. RESULTS Eighty-seven patients were enrolled in this study, and all patients had a minimum follow-up of 5 years (average 62.8 months) after grafting. Eighty-three patients (95.4%) achieved bone union, and the average union time was 6.77 months. Five patients (5.7%) experienced recurrence of infection. Complications included pin tract infection, fixation loosening, deformity connection, and limitation of joint range of motion (ROM). No significant differences in the infection control rate or bone defect union rate were noted between the two groups. The overall rate of complications in the external group was 50%, which was greater than that noted in the internal group (21.1%). CONCLUSIONS Locking compression plates are external fixators with smaller sizes that are easier to operate than conventional annular fixators or assembled external fixators. The use of locking compression plates in combination with the induced membrane technique in the treatment of tibia infected bone defects can achieve good clinical efficacy after medium-term follow-up.
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Affiliation(s)
- Hong Xiao
- Department of Orthopaedics, No. 958 Hospital of Army, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shulin Wang
- Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Feibo Wang
- Department of Orthopaedics, No. 958 Hospital of Army, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Sun Dong
- Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Shen
- Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhao Xie
- Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Alolabi N, Lovy AJ, Shin AY, Bishop AT. Medial femoral trochlea flap reconstruction: Clinical outcomes and perspectives. J Plast Reconstr Aesthet Surg 2020; 74:1991-1998. [PMID: 33455866 DOI: 10.1016/j.bjps.2020.12.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/10/2020] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We report our experience with use of the medial femoral trochlea (MFT) osteochondral flap for carpal applications. METHODS Outcomes of all patients treated with MFT flaps were reviewed. Healing, range of motion, grip strength, carpal alignment, pain, and complication data were collected. RESULTS MFT flaps were performed on seven patients with a mean age of 26.1 (range, 17-42) years. Indications included scaphoid proximal pole nonunion (n = 3), Kienböck's disease (n = 3), and Preiser's disease (n = 1). The mean follow-up was 32.3 (range, 5-70) months. Union was achieved in five patients at a mean of 12 (range 6-22) weeks. All five patients had increased grip strength and absence of pain at follow-up. There were two failures due to graft resorption. CONCLUSIONS The MFT osteochondral flap is a technically challenging yet powerful tool to replace the loss of both carpal articular cartilage and adjacent bone.
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Affiliation(s)
- Noor Alolabi
- Hand, Wrist & Peripheral Nerve Surgery, Division of Plastic & Reconstructive Surgery, Oakville Trafalgar Memorial Hospital, 2525 Old Bronte Road, Suite 560, Oakville, ON, L6M 4J2, Canada
| | - Andrew J Lovy
- Holy Cross Orthopedic Institute, Holy Cross Hospital, 5597 N Dixie Highway, Fort Lauderdale, FL 33334, Florida
| | - Alexander Y Shin
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester MN 55905, USA.
| | - Allen T Bishop
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester MN 55905, USA
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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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Donor-Site Morbidity of Vascularized Bone Flaps from the Distal Femur: A Systematic Review. Plast Reconstr Surg 2019; 142:363e-372e. [PMID: 30148786 DOI: 10.1097/prs.0000000000004691] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Vascularized grafts from the femur, including the medial femoral condyle and medial femoral trochlea, are increasingly being used. It is critical to understand the lower extremity complications from flap harvest. METHODS The authors searched available literature reporting on femoral flaps using PubMed, Embase, Cochrane Database, and Web of Science. After article selection, data were collected regarding demographics, procedure details, outcomes, and complications. The authors classified outcomes as good, fair, or poor based on pain, range-of-motion, sensory changes, subjective reporting, patient-reported outcomes, and other donor-site complications, including the need for additional procedures. RESULTS Two hundred twenty articles were identified. Forty-five met criteria for review, with data available for 283 patients. No patients had range-of-motion deficits beyond 1 year. Two percent of patients (six of 283) required additional donor-site procedures, with one report of a femur fracture after medial femoral condyle harvest. Only one study on 45 medial femoral trochlea patients presented patient-reported outcomes regarding the knee. Few objective data were presented. Twenty-eight articles presented adequate complication data for 252 patients to be rated as good, fair, or poor. Overall, 89 percent had good outcomes without donor-site complications. Of the 176 medial femoral condyle patients with outcomes reported, 92 percent had good outcomes; and 71 percent of the 48 medial femoral trochlea patients had good outcomes reported. CONCLUSIONS Overall, the reported donor-site morbidity from medial femoral condyle and medial femoral trochlea harvest is low. Chronic knee pain and sensory changes are most frequently reported, especially in medial femoral trochlea patients.
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Chronic Osteomyelitis of the Distal Femur Treated with Resection and Delayed Endoprosthetic Reconstruction: A Report of Three Cases. Case Rep Orthop 2017; 2017:5141032. [PMID: 28894615 PMCID: PMC5574225 DOI: 10.1155/2017/5141032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/18/2017] [Indexed: 11/17/2022] Open
Abstract
Chronic osteomyelitis involving the distal femur often results in amputation or arthrodesis. This article presents three cases of chronic osteomyelitis treated with a staged approach culminating in endoprosthetic reconstruction. Stage one involved resection of infected bone and placement of an intramedullary nail spanning the bony defect between proximal femur and tibia, with antibiotic cement packed around the nail. Patients were then placed on long-term IV +/- oral antibiotics to clear the infection. A "cooldown" period was then used between stages where patients were off antibiotics and inflammatory markers were monitored for signs of remaining infection. Stage two then involved reconstruction of the distal femur and knee with an endoprosthesis. In the appropriate patient, this treatment strategy offers another option in this challenging population.
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Vasculature of a Medial Femoral Condyle Free Flap in Intact and Osteotomized Flaps. Plast Reconstr Surg 2017; 139:992-997. [DOI: 10.1097/prs.0000000000003155] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Chronic osteomyelitis represents a progressive inflammatory process caused by pathogens, resulting in bone destruction and sequestrum formation. It may present with periods of quiescence of variable duration, whereas its occurrence, type, severity and prognosis is multifactorial. The ‘gold standard’ for the diagnosis of chronic osteomyelitis is the presence of positive bone cultures and histopathologic examination of the bone. Its management remains challenging to the treating physician, with a multidisciplinary approach involving radiologists, microbiologists with expertise in infectious diseases, orthopaedic surgeons and plastic surgeons. Treatment should be tailored to each patient according the severity and duration of symptoms, as well as to the clinical and radiological response to treatment. A combined antimicrobial and surgical treatment should be considered in all cases, including appropriate dead space management and subsequent reconstruction. Relapse can occur, even following an apparently successful treatment, which has a major impact on the quality of life of patients and is a substantial financial burden to any healthcare system.
Cite this article EFORT Open Rev 2016;1:128–135. DOI: 10.1302/2058-5241.1.000017.
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Affiliation(s)
- Michalis Panteli
- Academic Department of Trauma & Orthopaedics, Leeds General Infirmary; School of Medicine, University of Leeds, UK
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedics, Leeds General Infirmary; School of Medicine, University of Leeds, UK
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Medial Femoral Condyle Free Flap for Premaxillary Reconstruction in Median Facial Dysplasia. J Craniofac Surg 2017; 28:e57-e60. [DOI: 10.1097/scs.0000000000003199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kazmers NH, Thibaudeau S, Steinberger Z, Scott Levin L. Upper and lower extremity reconstructive applications utilizing free flaps from the medial genicular arterial system: A systematic review. Microsurgery 2016; 38:328-343. [DOI: 10.1002/micr.30138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/10/2016] [Accepted: 12/02/2016] [Indexed: 11/07/2022]
Affiliation(s)
| | - Stephanie Thibaudeau
- Division of Plastic and Reconstructive Surgery; McGill University; Montreal Quebec H3A 14A Canada
| | - Zvi Steinberger
- Department of Orthopaedic Surgery; Penn Medicine University City; Philadelphia Pennsylvania
| | - L. Scott Levin
- Department of Orthopaedic Surgery; Penn Medicine University City; Philadelphia Pennsylvania
- Division of Plastic Surgery; Perelman Center for Advanced Medicine; Philadelphia Pennsylvania
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