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Yamagata H, Nishida N, Imagama T, Okazaki T, Matsuki Y, Kaneoka T, Kawakami T, Kumaran Y, Suzuki H, Sakai T. Fracture risk assessment of vascularized medial femoral condylar bone graft: A finite element analysis. J Plast Reconstr Aesthet Surg 2024; 91:83-93. [PMID: 38402817 DOI: 10.1016/j.bjps.2024.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/15/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Vascularized medial femoral condyle (MFC) bone graft is useful for pseudarthrosis and osteonecrosis, but has the risk of fracture as a complication. This study aimed to create multiple three-dimensional (3D) finite element (FE) femur models to biomechanically evaluate the fracture risk in the donor site of a vascularized MFC bone graft. METHODS Computer tomography scans of the femurs of nine patients (four males and five females) with no left femur disease were enrolled in the study. A 3D FE model of the left femur was generated based on the CT images taken from the patients. The descending genicular artery (DGA), the main nutrient vessel in vascularized MFC bone grafts, divides into the proximal transversal branch (TB) and the distal longitudinal branch (LB) before entering the periosteum. Thirty-six different bone defect models with different sizes and locations of the harvested bone were created. RESULTS The highest stress was observed in the proximal medial and metaphyseal portions under axial and external rotation, respectively. In the bone defect model, the stress was most elevated in the extracted region's anterior or posterior superior part. Stress increased depending on proximal location and harvested bone size. CONCLUSION Increasing the size of the bone graft proximally raises the stress at the site of bone extraction. For bone grafting to non-load-bearing areas, bone grafting distally using LB can reduce fracture risk. If TB necessitates a larger proximal bone extraction, it is advisable to avoid postoperative rotational loads.
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Affiliation(s)
- Hiroki Yamagata
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan.
| | - Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan
| | - Takashi Imagama
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan
| | - Tomoya Okazaki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan
| | - Yuta Matsuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan
| | - Takehiro Kaneoka
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan
| | - Takehiro Kawakami
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan
| | - Yogesh Kumaran
- Departments of Bioengineering and Orthopedic Surgery, University of Toledo Colleges of Medicine and Engineering, 2801 W. Bancroft, Toledo, OH 43606, USA
| | - Hidenori Suzuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan
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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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3
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Miles MR, Jacobson L, Hill JB, Higgins JP, Giladi AM, Pet MA. Patient-Reported Lower Extremity Outcomes Following Fibula or Medial Femoral Condyle Free Flaps for Upper Extremity Defects. Hand (N Y) 2023; 18:1005-1011. [PMID: 35081813 PMCID: PMC10470229 DOI: 10.1177/15589447211073827] [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: 02/10/2023]
Abstract
BACKGROUND Free fibula flap (FFF) and medial femoral condyle (MFC) flap are commonly used for upper extremity osseous reconstruction, yet donor-site morbidity has never been systematically compared. METHODS Patients who underwent an FFF or MFC for upper extremity extra-carpal osseous reconstruction at 3 academic hand centers were retrospectively identified. Only patients who underwent reconstruction for a defect in which either flap type is routinely used or has been described in the literature were deemed eligible. Patients who agreed to participate were asked to complete the Lower Extremity Functional Scale (LEFS) and Lower Limb Core Scale (LLCS). The reported population norm median score of LEFS is 77 points. The LLCS population norm mean score is 90.52 points. RESULTS Twenty-one patients (10 MFC, 11 FFF) were enrolled. The median LEFS score for patients after MFC was 76 (interquartile range [IQR], 49-80) points and 75 (IQR, 56-79) points after FFF. The median LLCS score for patients after MFC was 96.4 (IQR, 87.9-100) points and 100 (IQR, 91-100) points after FFF. Median LEFS scores were slightly below the population norm, whereas median LLCS scores were above the norm for both FFF and MFC. All patients stated they would have the surgery again and that any dysfunction or pain in the leg was justified by the benefit in the arm. CONCLUSIONS When considering whether to use an MFC or FFF for upper extremity reconstruction, both flap types appear to result in modest and comparable donor-site morbidity.
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Tee R, Harvey JN, Tham SK, Ek ET. Medial Femoral Condyle Corticoperiosteal Flap for Failed Total Wrist Fusions. J Wrist Surg 2023; 12:288-294. [PMID: 37564622 PMCID: PMC10411124 DOI: 10.1055/s-0043-1760737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 12/03/2022] [Indexed: 01/22/2023]
Abstract
Background Recalcitrant nonunion following total wrist arthrodesis is a rare but challenging problem. Most commonly, in the setting of failed fusion after multiple attempts of refixation and cancellous bone grafting, the underlying cause for the failure is invariably multifactorial and is often associated with a range of host issues in addition to poor local soft-tissue and bony vascularity. The vascularized medial femoral condyle corticoperiosteal (MFC-CP) flap has been shown to be a viable option in a variety of similar settings, which provides vascularity and rich osteogenic progenitor cells to a nonunion site, with relatively low morbidity. While its utility has been described for many other anatomical locations throughout the body, its use for the treatment of failed total wrist fusions has not been previously described in detail in the literature. Methods In this article, we outline in detail the surgical technique for MFC-CP flap for the management of recalcitrant aseptic nonunions following failed total wrist arthrodesis. We discuss indications and contraindications, pearls and pitfalls, and potential complications of this technique. Results Two illustrative cases are presented of patients with recalcitrant nonunions following multiple failed total wrist fusions. Conclusion When all avenues have been exhausted, a free vascularized corticoperiosteal flap from the MFC is a sound alternative solution to achieve union, especially when biological healing has been compromised. We have been able to achieve good clinical outcomes and reliable fusion in this difficult patient population.
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Affiliation(s)
- Richard Tee
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Jason N. Harvey
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
- Orthosport Victoria, Richmond, Melbourne, Victoria, Australia
| | - Stephen K. Tham
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
- Victorian Hand Surgery Associates, Fitzroy, Melbourne, Victoria, Australia
| | - Eugene T. Ek
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
- Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
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Merits of the free periosteal femoral condyle flap in the management of advanced mandibular osteoradionecrosis. Int J Oral Maxillofac Surg 2023; 52:175-180. [PMID: 35717279 DOI: 10.1016/j.ijom.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/12/2022] [Accepted: 05/19/2022] [Indexed: 01/11/2023]
Abstract
The management of advanced mandibular osteoradionecrosis (ORN) is poorly codified and requires repeated time-consuming, morbid surgical procedures. The free periosteal medial femoral condyle flap could be used for the management of extensive mandibular ORN with fracture, to avoid non-conservative surgery such as mandibulectomy. The purpose of this study was to report the authors' experience using periosteal flaps for advanced ORN and to assess the therapeutic effectiveness of these flaps in this context. A series of 10 patients who underwent bone revascularization with a free periosteal femoral flap for the management of advanced ORN (Notani class III) is reported. The onset of bone consolidation, length of hospital stay, duration of surgery, donor site morbidity, and the option of dental rehabilitation in the event of a successful outcome were assessed. Osteogenesis was observed in 70% of cases. Thirty percent of patients benefited from dental implant rehabilitation. The mean follow-up was 73.1 months. No patient experienced any sequelae at the flap harvest site. In the authors' opinion, the free periosteal medial femoral condyle flap appears to offer a therapeutic solution for patients with advanced stages of ORN.
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Analysis of intraoral microvascular anastomosis in maxillofacial defects reconstruction. J Craniomaxillofac Surg 2023; 51:31-43. [PMID: 36725484 DOI: 10.1016/j.jcms.2023.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
This review summarizes the research progress in the field of intraoral microvascular anastomosis techniques (IAT) and attempts to investigate the indications for procedures in which IAT can be applied, the surgical procedure and the difficulties involved, technical assessments, result evaluation and the perspective. Currently, microvascular anastomosis technique is widely used in maxillofacial defects reconstruction from various causes including cutaneous injury or congenital deformity which usually required extensive flap reconstruction and therefore a vascular free flap is routinely used. Conventional microvascular anastomosis reconstruction techniques cannot avoid new incisions, which will affect the postoperative aesthetic situation. Surgeons have therefore attempted to improve this technique to effectively eliminate scars caused by surgery: some patients can be chosen to undergo microvascular anastomosis of the free flap intraorally, thus reducing the extraoral incision caused by the anastomosis located in neck or maxillofacial improving the postoperative appearance of the patients. In addition to preserving the external appearance, intraoral anastomosis technique (IAT) can also solve some other problems of maxillofacial vascular anastomosis, such as insufficient vessel pedicle length and high risk of facial nerve injury.
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7
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Rodriguez JR, Chan JKK, Huang RW, Chen SH, Lin CH, Lin YT, Lin CH, Hsu CC. Free Medial Femoral Condyle Flap for Phalangeal and Metacarpal Bone Reconstruction. J Plast Reconstr Aesthet Surg 2022. [DOI: 10.1016/j.bjps.2022.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Guzzini M, Arioli L, Mori F, Ferretti A. Is it really necessary to perform venous anastomosis in vascularized corticoperiosteal bone flap? A randomized prospective 4-year follow-up study. Injury 2022; 53:2859-2864. [PMID: 35753816 DOI: 10.1016/j.injury.2022.06.022] [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] [Received: 02/27/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aims to investigate the treatment results of atrophic nonunion of the lower and upper limb with vascularized bone flaps performed with only arterial anastomosis versus the execution of flaps performed with arterial and venous anastomosis, comparing the surgical time and the healing rate of these two techniques. METHODS 49 patients were enrolled in this study and were randomly divided into two groups: group A, the control group, consisted of 27 patients, who underwent vascularized corticoperiosteal bone flap with both arterial and venous anastomosis; group B, consisted of 22 patients, who underwent vascularized corticoperiosteal bone flap with only arterial anastomosis. The surgical time, the time to harvest the graft and the microsurgical time were evaluated. Radiological and clinical follow-ups were performed with one independent and blinded investigator to avoid bias. RESULTS A significant reduction in the duration of the intervention in group B was found: a 13.63% reduction of the total surgical time and a 41.75% reduction of the microsurgical time. A significant difference was not found between groups A and B in bone healing time. All the patients of both groups were able to return to their daily life activities. CONCLUSIONS Our investigation suggests that it isn't necessary to perform the venous anastomosis between the flap pedicle and the recipient area. Presumably, the venous blood flow reaches the systemic circulation through the vascular bone marrow network. Our procedure avoids venous trauma during the dissection and execution of the anastomosis and, therefore, can minimize complications such as venous thrombosis.
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Affiliation(s)
- Matteo Guzzini
- "Sapienza" University of Rome, Unit of Orthopedics and Traumatology, S. Andrea University Hospital, Via Grottarossa, 1035, 00186, Rome, Italy
| | - Leopoldo Arioli
- "Sapienza" University of Rome, Unit of Orthopedics and Traumatology, S. Andrea University Hospital, Via Grottarossa, 1035, 00186, Rome, Italy.
| | - Fabiana Mori
- "Università degli studi di Padova", Unit of Orthopedics and Traumatology, University Hospital of Padua, Via Nicolò Giustiniani, 1, 35128 Padua, Italy
| | - Andrea Ferretti
- "Sapienza" University of Rome, Unit of Orthopedics and Traumatology, S. Andrea University Hospital, Via Grottarossa, 1035, 00186, Rome, Italy
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9
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Guzzini M, Lupariello D, Argento G, Arioli L, Ferretti A. Vascular and Bone Regeneration of the Donor Site After Corticoperiosteal Flap From the Medial Femoral Condyle. Hand (N Y) 2022; 17:366-372. [PMID: 32686510 PMCID: PMC8984706 DOI: 10.1177/1558944720930299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The aim of this study was to evaluate the morbidity and regeneration of descending genicular artery and bone on the donor site, the medial condyle of the femur, after harvesting the corticoperiosteal flap and to report the clinical, functional, and radiographic outcomes of the treatment of atrophic nonunions of upper limb with corticoperiosteal vascularized flap at 5-year follow-up. Methods: From January 2011 to January 2018, 36 patients (average age of 45.8 years) were enrolled and evaluated with clinical and radiographic follow-up (average time of 66 months). In 20 patients, magnetic resonance angiography was also performed preoperatively and postoperatively to investigate the fate of the descending genicular artery after harvesting the corticoperiosteal flap. Results: Radiographic evaluation demonstrated a success rate of 94.4% (average time of bone healing of 5.2 months). At the recipient site, clinical evaluation showed excellent results in 75% to 80% of cases, and at the donor site, no statistical differences were found between before and after surgery clinical condition. In all patients who underwent magnetic resonance imaging, images showed a complete recovery of the blood supply of the medial femoral condyle. Conclusions: Medial condyle corticoperiosteal flap represents a valid choice for the treatment of upper limb nonunions. This technique brings a very low morbidity on the donor site, with complete restoration of blood supply and bone tissue. The limit of this flap is its low mechanical support, which suggests performing this technique especially for the treatment of upper limb nonunions.
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Affiliation(s)
- Matteo Guzzini
- S. Andrea Hospital, University of Rome
“La Sapienza”, Rome, Italy
| | | | - Giuseppe Argento
- S. Andrea Hospital, University of Rome
“La Sapienza”, Rome, Italy
| | - Leopoldo Arioli
- S. Andrea Hospital, University of Rome
“La Sapienza”, Rome, Italy,Leopoldo Arioli, Unit of Orthopedics and
Traumatology, S. Andrea Hospital, University of Rome “La Sapienza”, Via di
Grottarossa, 1035-1039, 00189 Rome, Italy.
| | - Andrea Ferretti
- S. Andrea Hospital, University of Rome
“La Sapienza”, Rome, Italy
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DeKeyser GJ, Bailey TL, Higgins TF, Tyser AR. Treatment of Recalcitrant Femoral Shaft Nonunion With Medial Femoral Condyle Pedicled Autograft: Technical Trick. J Orthop Trauma 2022; 36:e80. [PMID: 34050083 DOI: 10.1097/bot.0000000000002186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 02/02/2023]
Abstract
SUMMARY Nonunited fractures of the femoral shaft and distal femur are usually successfully addressed with stabilization with or without autogenous bone grafting. For the small subset of these problems that prove recalcitrant to front-line treatment, a pedicled medial femoral condyle (MFC) bone flap can provide a source of vascularized autograft with minimal donor site morbidity. The MFC has gained recent widespread adoption as a free vascularized bone transfer, and here, we present a surgical technique and retrospective analysis of patients treated with a pedicled MFC technique. This serves as a useful treatment option for these difficult problems and may be especially helpful in low resource environments or where microsurgical anastomosis is not feasible.
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Affiliation(s)
- Graham J DeKeyser
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
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Schmidt M, Holzbauer M, Froschauer SM. Metacarpal reconstruction with a medial femoral condyle flap based on a 3D-printed model: a case report. Case Reports Plast Surg Hand Surg 2022; 9:52-56. [PMID: 35083370 PMCID: PMC8786248 DOI: 10.1080/23320885.2022.2029453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
Metacarpal bone reconstruction renders a surgical challenge. We describe a case using 3D printing assisted medial femoral condyle flap for extensive metacarpal reconstruction after wide resection of a large giant cell tumor recurrence. Thus, the length and stability of the entire third ray could be restored without any tumor recurrence. (50 w)
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Affiliation(s)
- Manfred Schmidt
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Matthias Holzbauer
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Clinic for Orthopedics and Traumatology, Kepler University Hospital, Linz, Austria
| | - Stefan M. Froschauer
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Clinic for Orthopedics and Traumatology, Kepler University Hospital, Linz, Austria
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12
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Addressing common orthopaedic calamities with microsurgical solutions. Injury 2021; 52:3561-3572. [PMID: 34030865 DOI: 10.1016/j.injury.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/04/2021] [Indexed: 02/02/2023]
Abstract
Reconstructive microsurgery has been an essential aspect of orthopaedic surgery and extremity reconstruction since the introduction of the operating microscope in the mid-20th century. The reconstructive ladder ranges from simple healing by secondary intention to complex procedures such as free tissue transfer and vascularized composite allotransplantation. As orthopaedic surgery has evolved over the past 60 years, so too have the reconstructive microsurgical skills that are often needed to address common orthopaedic surgery problems. In this article, we will discuss a variety of complex orthopaedic surgery scenarios ranging from trauma to infection to tumor resection as well as the spectrum of microsurgical solutions that can aid in their management.
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Klarendić A, Dovšak T. Femur Fracture Following Medial Femoral Condyle Flap Harvest: A Case Report. OPEN ACCESS SURGERY 2021. [DOI: 10.2147/oas.s333899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Impact on periosteal vasculature after dual plating of the distal femur: a cadaveric study. OTA Int 2021; 4:e131. [PMID: 34746663 PMCID: PMC8568473 DOI: 10.1097/oi9.0000000000000131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/03/2021] [Accepted: 03/07/2021] [Indexed: 11/26/2022]
Abstract
Although dual plating of distal femur fractures has been described for injuries at risk of varus displacement, the vascular insult to the medial distal femur utilizing this technique is unknown. The aim of this study was to evaluate the perfusion of the medial distal femoral periosteal arteries after supplemental medial plating of the distal femur. Methods Fifteen human fresh-frozen cadaveric femora were thawed and randomized to lateral locked plating alone or with supplemental medial plate fixation. Conventional submuscular medial plating was performed using a 12-hole small fragment plate and multiple cortical screws. The superficial femoral artery was injected with latex dye. Specimens were dissected. The patency of the medial distal femoral periosteal vessels was evaluated. Results Four vessels were consistently observed traversing the distal medial femur: the transverse and descending (d-MMPA) branches of the medial metaphyseal periosteal artery, and the transverse and longitudinal branches of the descending geniculate artery. The anterior longitudinal arch (ALA) was present in 13 of 15 specimens and was fed by the d-MMPA. The median number of periosteal arteries occluded by the medial plate was 2 (6 out of 8 specimens). The d-MMPA was occluded in 6 of 8 medially plated femurs, resulting in a complete lack of perfusion of the ALA. Conclusions Submuscular medial plating of the distal femur compressed the d-MMPA in the majority of specimens. This vessel gives rise to the ALA, which lacked perfusion in these specimens. This vascular insult could affect the healing of metaphyseal distal femur fractures treated with dual plating.
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15
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Boghossian E, Stewart DA. The Medial Metaphyseal Periosteal Artery (MMPA): An Alternate Pedicle for the Medial Femoral Trochlea Flap. J Hand Surg Am 2021; 46:1032.e1-1032.e3. [PMID: 33526296 DOI: 10.1016/j.jhsa.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 06/25/2020] [Accepted: 11/11/2020] [Indexed: 02/02/2023]
Abstract
We report a case of medial femoral trochlea flap used for scaphoid proximal pole reconstruction, in which the transverse branch of the descending genicular artery was vestigial. The medial metaphyseal periosteal artery was clearly the dominant pedicle supplying the trochlear region. The flap was safely raised on the medial metaphyseal periosteal artery pedicle. The incidence of this uncommon presentation remains unknown and this anatomical variant is newly described.
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Affiliation(s)
- Elie Boghossian
- Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, North Shore Private Hospital, University of Sydney, Sydney, Australia
| | - David A Stewart
- Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, North Shore Private Hospital, University of Sydney, Sydney, Australia.
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"Use of pedicled corticoperiosteal flap in resistant cases of distal femur non-union: Our learning experience". J Plast Reconstr Aesthet Surg 2021; 75:621-628. [PMID: 34732336 DOI: 10.1016/j.bjps.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/04/2021] [Accepted: 09/19/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Nonunion of distal femur is a complex problem with the added burden of poor bone stock, osteopenia, and joint contracture. Various procedures are described ranging from osteosynthesis using auto/allograft, to use of mega prosthesis. Use of vascularized corticoperiosteal flap based on descending genicular artery and superomedial genicular artery is a new technique to provide living vascular graft for the nonunion site. Although few free corticoperiosteal flap reconstructions have been reported in the past for these distal femur nonunions, this flap has seldom been used as a pedicled variety. Through this article, we aimed at highlighting the main obstacles faced while using pedicled corticoperiosteal flap for these patients given its dearth in literature. MATERIALS AND METHODS Five patients of at least two previously failed osteosynthesis for distal femur fracture non-union were selected for performing corticoperiosteal flaps. The intraoperative findings that were both favourable and unfavourable were documented along with the outcome of procedure in the form of callus formation or fracture healing. RESULTS Dissection of the flap was more tedious in these cases than when performed for a different indication in a virgin territory. However, despite the previous trauma resulting in decreased pliability of their vessels, all flaps were viable at the end of procedure with favourable cosmetic and functional outcomes. CONCLUSION Despite the complexities in flap harvest, use of the less morbid and technically easier "Pedicled corticoperiosteal flap" and osteosynthesis along with the auto technique is a worthwhile option for retaining the native joint with favourable outcome in non-unions of distal femur.
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Castillo-Vázquez FG, Palafox-Carral I, Romo-Rodríguez R, Limón-Muñoz M, Farías-Cisneros E. Surgical Solution for Total Carpectomy due to Destructive Wrist Pan-Osteomyelitis Using a Free Femoral Condyle Osteocutaneous Flap for Wrist Arthrodesis. J Hand Microsurg 2021; 14:100-106. [DOI: 10.1055/s-0041-1736083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractOsteomyelitis of the hand is rare, even more so in the carpal bones. Patients with rheumatoid arthritis (RA) have a higher infection rate overall, and up to a 14-fold increase in the incidence of septic arthritis of the hand. The destruction of immunologic barriers, such as cartilage and joint capsules, as well as the use of immunosuppressive medications will have an impact on the higher incidence of articular infections and osteomyelitis in these patients. Infection in these cases is often overlooked because of the similarity of presentation to an acute event of RA. When osteomyelitis is present, rapid and aggressive treatment should be given. Surgical debridement, lavage, and excision of necrotic bone is the best choice, followed by cemented antibiotic impregnated spacer to resolve the acute scenario. Vascularized bone grafts (VBG) can then be used for a definitive solution, as these have great biologic properties that increase the possibility of a good outcome. We hereby present a report of a wrist arthrodesis, using a free medial femoral condyle VBG for the treatment of destructive osteomyelitis of the carpal bones in a female patient with RA.
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Affiliation(s)
| | - Ignacio Palafox-Carral
- Orthopedic Surgery Resident, Department of Orthopedic Surgery, Hospital Español de México, Mexico City, Mexico
| | | | - Marisol Limón-Muñoz
- Anesthesiology Division, Department of Regional Anesthesiology, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra,” CDMX, Mexico
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18
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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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19
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Singh K, Huang TCT, Meaike JD, Mills AM, Nathan JM, Lettieri SC, Arce K, Moran SL. The Medial Femoral Condyle Free Flap for Reconstruction of Recalcitrant Defects in the Head and Neck. Ann Plast Surg 2021; 87:291-297. [PMID: 34397517 DOI: 10.1097/sap.0000000000002736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Small recalcitrant defects of the mandible and maxilla may be secondary to tumor, trauma, infection, and congenital origin. Vascularized bone grafting has been shown to effectively manage these defects; however, donor sites are limited. The vascularized medial femoral condyle (MFC) provides adequate cortical cancellous bone with the option of a skin island, consistent anatomy, and minimal donor site morbidity. This article outlines the use of the MFC flap for maxillomandibular reconstruction. METHODS A retrospective chart review of patients who required segmental maxillomandibular reconstruction with the MFC flap was conducted. A total of 9 patients (5 men and 5 women) with an average age of 45.3 years were identified. The etiology of the defects, flap sizes, and postoperative outcomes were recorded. RESULTS Three patients had osteoradionecrosis of the neomandible after irradiation of the free fibula reconstruction, 3 patients had defects after cancer extirpation (1 mandible, 2 maxillary), 1 patient had a maxillary defect from trauma, and 2 patients had a residual cleft palate defect. All defects failed initial treatment with nonvascularized bone grafts. The average dimensions of the MFC flaps were 1.2 × 2.5 × 4 cm. Two of 9 flaps included a skin island. Eight flaps survived completely, but 1 patient suffered from flap failure requiring debridement and resulted in an oroantral fistula. Four patients received endosseous dental implants. Average time to union was 6.7 months, and average time to implant was 6.75 months. The average follow-up time was 24.9 months. CONCLUSIONS The MFC flap is useful in the reconstruction of small segmental maxillomandibular defects and for the salvage of a neomandible after osteoradionecrosis. The MFC flap provides a reliable platform for endosseous dental implants and serves as an alternative source of vascularized bone reconstruction in the head and neck.
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Affiliation(s)
- Kuldeep Singh
- From the Division of Plastic Surgery, Department of Surgery
| | - Tony C T Huang
- From the Division of Plastic Surgery, Department of Surgery
| | - Jesse D Meaike
- From the Division of Plastic Surgery, Department of Surgery
| | - Andrew M Mills
- From the Division of Plastic Surgery, Department of Surgery
| | - John M Nathan
- Section of Head and Neck Oncologic Surgery and Reconstruction, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | | | - Kevin Arce
- Section of Head and Neck Oncologic Surgery and Reconstruction, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Steven L Moran
- From the Division of Plastic Surgery, Department of Surgery
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20
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Abstract
BACKGROUND The use of free flaps from the medial femoral condyle has grown in popularity and is now a workhorse in the reconstruction of skeletal defects. The utility of this technique has not yet been described for the pediatric patient population. The authors present their series of pediatric patients who underwent surgery using a medial femoral condyle free flap or a variant thereof in skeletal reconstruction and demonstrate the efficacy of this technique in this population. METHODS A multi-institutional retrospective review of patients aged 18 years or younger who required a medial femoral condyle flap for skeletal reconstruction was undertaken. Operative technique, radiographs, and clinical outcomes were recorded. A novel technique (Innocenti) was used to avoid the distal femoral physis in which a Kirschner wire was placed under fluoroscopic guidance just proximal to the growth plate. RESULTS Thirteen patients met inclusion criteria, with an average age of 14.7 years (range, 7 to 18 years) and mean follow-up of 28 months (range, 3 to 120 months). Six were skeletally immature at the time of medial femoral condyle harvest, with the last patient having organic bone disease, putting her at risk for pathologic fracture. All 13 patients achieved bony union, and no patients suffered pathologic fractures or physeal injuries; no patients developed length discrepancies. CONCLUSIONS The authors present the first series of corticocancellous medial femoral condyle free flaps in the pediatric population along with a novel technique to avoid injury to the physis in skeletally immature patients. This technique is effective for a variety of skeletal defects or nonunions and is safe for growing patients without causing physeal arrest or growth disturbance. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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21
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Pet MA. Vascularized Bone Flaps for Carpal Reconstruction. MISSOURI MEDICINE 2021; 118:147-152. [PMID: 33840858 PMCID: PMC8029614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Within the field of hand and upper extremity surgery, reconstruction of the bony carpus remains a perplexing task and is a field undergoing rapid evolution. Among the eight bones of the carpus, the scaphoid and lunate are most frequently affected by traumatic and avascular processes which render their articular surfaces degenerated and painful. These conditions include scaphoid waist fracture, scaphoid proximal pole fracture, and Kienböck's disease of the lunate. While traditional salvage operations with limited functional outcomes have historically been employed for management of these unsolved problems, advances in microsurgical understanding and capability are changing the treatment algorithm at our center. This paradigm shift centers in large part around the introduction of new techniques for vascularized bone and cartilage transfer for carpal reconstruction.
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Affiliation(s)
- Mitchell A Pet
- Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri
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22
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Ring A, Beutel H, Udrescu GA, Farzaliyev F. [Microvascular reconstruction of foot defects using a free femoral periostal flap]. DER ORTHOPADE 2021; 50:306-311. [PMID: 33416924 DOI: 10.1007/s00132-020-04064-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The reconstruction of defects in the foot region is a challenge due to the anatomical peculiarities of the soft tissue covering. OBJECTIVE This article presents the results of the reconstruction of postoperative foot defects using the free femoral periosteal flap (FFPF). MATERIAL AND METHODS In a patient collective (n = 10) with postoperative wound healing disorders of the foot, the defect zone was covered using a vascularized FFPF from the distal femoral region. The wound healing process was retrospectively analyzed. RESULTS The mean follow-up time was 20.2 ± 8.22 months (7-35 months). All patients had a soft tissue defect in the foot region with a mean area of 17.9 ± 3.72 cm2 (12-24 cm2). On average, a wound healing disorder occurred 2 weeks after the primary surgery. In the group of patients followed up the vascularized FFPF enabled a stable, definitive and aesthetically pleasing reconstruction and contributed to the bony consolidation. The duration of inpatient care after defect closure was 8-10 days and was significantly less than the duration of wound management prior to transplantation of the FFPF. CONCLUSION The FFPF is an effective and elegant method for the regenerative reconstruction of defects with accompanying osseous components in the foot region. The FFPF has the advantage of instant thin and pliable tissue coverage in contrast to many other reconstructive methods. The FFPF can promote wound consolidation through the regenerative properties of a vascularized periosteal sheath in the context of a one-step and permanent infection control.
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Affiliation(s)
- Andrej Ring
- Klinik für Plastische und Rekonstruktive Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland. .,Ruhr-Universität Bochum, Bochum, Deutschland.
| | - Hendrik Beutel
- Klinik für Plastische und Rekonstruktive Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland.,Ruhr-Universität Bochum, Bochum, Deutschland
| | - George Augustin Udrescu
- Klinik für Plastische und Rekonstruktive Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland
| | - Farhad Farzaliyev
- Klinik für Plastische und Rekonstruktive Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland.,Klinik für Allgemein- Viszeral und Transplantationschirurgie, Universitätsklinikum Essen, Essen, Deutschland
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23
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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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24
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Temporomandibular joint reconstruction with medial femoral condyle osseocartilaginous flap: a case series. Int J Oral Maxillofac Surg 2020; 50:604-609. [PMID: 33041166 DOI: 10.1016/j.ijom.2020.09.017] [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: 06/04/2020] [Revised: 07/25/2020] [Accepted: 09/21/2020] [Indexed: 11/21/2022]
Abstract
Reconstruction for large-scale temporomandibular joint (TMJ) defects can be challenging. We have used the medial femoral condyle (MFC) osseocartilaginous flap for repair of TMJ defects. The aim of this paper was to describe our technique and to present the preliminary results. The MFC osseocartilaginous flap was used as a free vascularized graft for TMJ defect in four patients who had undergone resection for benign tumor of the TMJ region (n = 2) or TMJ ankylosis (n=2). A computer-assisted technique was used in all cases. Symmetry of the mandible was objectively evaluated by postoperative computed tomography. Complications were recorded during follow-up visits. Lower extremity functional status was assessed by the Lower Extremity Functional Scale (LEFC) questionnaire. The MFC osseocartilaginous flap success rate was 100%; bony union was obtained in all four patients, and normal occlusion was achieved within 6-11 months after surgery. No flap-related complications occurred. All patients were satisfied with their postoperative facial symmetry and oral function. The LEFC score ranged from 72 to 80, indicating normal lower extremity function. Vascularized MFC osseocartilaginous flap appears to be a reliable option for reconstruction of large-scale TMJ defects.
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25
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26
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Barret H, Remy H, Piereschi S, Camuzard O. [Medial femoral condyle free flap for reconstruction of carpometacarpal bone defect after giant cell tumour of tendon synovial sheath resection]. ANN CHIR PLAST ESTH 2020; 66:86-92. [PMID: 32854971 DOI: 10.1016/j.anplas.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/30/2020] [Accepted: 06/08/2020] [Indexed: 10/23/2022]
Abstract
We report the case of a 23-year-old patient treated for a large giant cell tumour of the synovial sheaths of the ulnar edge of the hand and wrist invading the triquetrum, the hamatum, the ulnar part of the capitate as well as the bases of the 3rd, 4th and 5th metacarpals and the floor of the Guyon's canal and the carpal tunnel. A monobloc resection was performed in a healthy margin ; the loss of bone substance was 7×3.5cm. We performed a bone reconstruction using a cortico-cancellous medial femoral condyle free flap of 8×4cm. Postoperative follow-up was uneventful and bone consolidation was achieved at 2,5 months postoperatively. The cortico-cancellous medial femoral condyle free flap is an interesting option for treating small and medium size bone loss in the hand and wrist. Its use in its pure bone form or in its chimeric form with muscle, cartilage or skin opens up a wide range of choices for the reconstructive surgeon.
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Affiliation(s)
- H Barret
- Service de chirurgie plastique, reparatrice et SOS Main, IULS, CHU de Nice, hôpital Pasteur 2, Nice, France
| | - H Remy
- Service de chirurgie plastique, reparatrice et SOS Main, IULS, CHU de Nice, hôpital Pasteur 2, Nice, France
| | - S Piereschi
- Service de chirurgie plastique, reparatrice et SOS Main, IULS, CHU de Nice, hôpital Pasteur 2, Nice, France
| | - O Camuzard
- Service de chirurgie plastique, reparatrice et SOS Main, IULS, CHU de Nice, hôpital Pasteur 2, Nice, France; Laboratoire d'anatomie humaine, faculté de médecine de Nice, Université Côte d'Azur, 28, avenue de Valombrose, 06107 Nice cedex 2, France.
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27
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Medial Femoral Condyle Vascularized Bone Graft for Treatment of Midshaft Clavicle Recalcitrant Nonunion With Use of the Transverse Cervical Artery as an Anastomosis. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:JAAOSGlobal-D-19-00049. [PMID: 32656481 PMCID: PMC7322782 DOI: 10.5435/jaaosglobal-d-19-00049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 10/24/2019] [Indexed: 12/01/2022]
Abstract
Vascularized medial femoral condyle bone grafts have been reported to be a reliable treatment for recalcitrant bony nonunions of the extremities. Although clavicle fracture nonunions are rare after treatment with open reduction internal fixation, symptomatic nonunions can be a challenge. The medial femoral condyle vascularized bone graft has been described as a treatment option for clavicle nonunions with the thoracoacromial trunk as the recipient anastomosis site. This case illustrates how the transverse cervical artery and accompanying veins can be used as an anastomosis when the thoracoacromial trunk is inaccessible because of previous surgical- and infection-related scaring. At the final follow-up, the patient had returned to full duty and resumed competitive triathlons. Radiographs demonstrated complete healing of clavicle fracture.
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28
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Use of a Free Vascularized Medial Femoral Condyle Flap for Revision Surgery in a Pediatric Patient with Congenital Pseudarthrosis of the Clavicle. Case Rep Orthop 2020; 2020:8872934. [PMID: 32685226 PMCID: PMC7341426 DOI: 10.1155/2020/8872934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022] Open
Abstract
The most common surgical treatment for congenital pseudarthrosis of the clavicle (CPC) is resection of the pseudarthrosis, placement of an autologous bone graft, and Kirschner wire or plate fixation. However, in some cases, bone fusion cannot be achieved at the first surgery, and an additional surgery is required. We present a case report of a boy with a right CPC who failed radiographic bone union after the first surgery. He subsequently underwent revision surgery with resection of the pseudarthrosis, plate fixation, and establishment of a vascularized medial femoral condyle (MFC) flap to ensure bone union. Three months after the revision surgery, a radiographic bone union was achieved, and no symptoms were observed for one year after the operation. There have been no previous reports of the use of a vascularized MFC flap as a treatment for CPC. We believe that this technique effectively ensures bone union during revision surgery for CPC.
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29
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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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30
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Keller M, Kastenberger T, Anoar AF, Kaiser P, Schmidle G, Gabl M, Arora R. Clinical and radiological results of the vascularized medial femoral condyle graft for scaphoid non-union. Arch Orthop Trauma Surg 2020; 140:835-842. [PMID: 32124031 PMCID: PMC7244456 DOI: 10.1007/s00402-020-03386-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This study evaluated the use of a free vascularized bone graft with and without cartilage from the medial femoral condyle (MFC) in patients with recalcitrant scaphoid non-union, with a special focus on union rates and the osteochondral graft for proximal pole destruction. MATERIALS AND METHODS Thirty-eight avascular scaphoid non-unions in 37 patients who were treated with a free osteoperiosteal or osteochondral MFC graft were retrospectively evaluated (mean follow-up 16 months). Bone union, the scapholunate and the radiolunate angles were evaluated on X-ray images. The range of motion, grip strength, VAS, DASH and PRWE scores were evaluated clinically. RESULTS The overall union rate was 95%. Bone union was achieved in 27 out of 29 (93%) scaphoids treated with a free osteoperiosteal MFC grafts and in 9 out of 9 (100%) scaphoids treated with a free osteochondral MFC graft. The range of motion remained almost unchanged, while grip strength increased significantly (34 kg vs. 44 kg) and the VAS (22-5), DASH (59-19) and PRWE (62-30) score decreased significantly. The scapholunate (71°-65°) and radiolunate (28°-18°) angle decreased. No major donor site morbidity was observed. Postoperative complications were observed in eight cases (21%). CONCLUSIONS The vascularized medial femoral bone graft leads to a good functional outcome in the treatment of scaphoid non-unions. The graft provides adequate blood supply and structural stability to the scaphoid. A proximal pole destruction can be replaced using an osteochondral graft with promising short-term results preventing carpal osteoarthritis and collapse.
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Affiliation(s)
- Marco Keller
- grid.5361.10000 0000 8853 2677Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria ,grid.440128.b0000 0004 0457 2129Department of Orthopaedics and Traumatology, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Tobias Kastenberger
- grid.5361.10000 0000 8853 2677Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Anizar Faizi Anoar
- grid.412516.50000 0004 0621 7139Department of Orthopaedics and Traumatology, Kuala Lumpur Hospital, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - Peter Kaiser
- grid.5361.10000 0000 8853 2677Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Gernot Schmidle
- grid.5361.10000 0000 8853 2677Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Markus Gabl
- grid.5361.10000 0000 8853 2677Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Rohit Arora
- grid.5361.10000 0000 8853 2677Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Affiliation(s)
| | | | | | - Amr S Elgazzar
- Faculty of Medicine, Benha University, Benha, Qalyubia, Egypt
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The Anterolateral Thigh-Medial Femoral Condyle Chimeric Flow-through Flap for Posttraumatic Wrist Arthrodesis. Tech Hand Up Extrem Surg 2019; 23:143-145. [PMID: 31454335 DOI: 10.1097/bth.0000000000000247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Wrist arthrodesis in the setting of segmental bone loss can have high failure rates. Therefore, vascularized bone grafting has been advocated for select patients. Patients suffering concomitant large soft tissue loss present even greater challenge. To that end, we describe for the first time successful anterolateral thigh-medial femoral condyle chimeric flow-through flap for posttraumatic wrist arthrodesis and soft tissue coverage. This is a case report of a 19-year-old male laborer who suffered a large blast injury resulting in significant bone and soft tissue injury to the dominant right hand and wrist. After multiple debridements, there was a segmental bone defect from the distal radius and ulna to the metacarpal bases, as well as a 12×8 cm dorsal soft tissue defect. This was reconstructed with a anterolateral thigh-medial femoral condyle chimeric flow-through flap and concomitant wrist arthrodesis in a single stage. Besides a donor site thigh seroma, recovery was uneventful with clinical and radiographic evidence of fusion by >9 weeks postoperation.
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Abstract
Management of scaphoid nonunions requires thoughtful preoperative and intraoperative consideration to evaluate for scaphoid flexion or humpback deformity, carpal collapse, and proximal pole vascularity. Most scaphoid nonunions do not require vascularized bone grafts; however, in the setting of avascular necrosis of the proximal pole, vascularized bone grafts should be used to optimize union rates. In addition, scaphoid geometry and carpal stability must be restored to enhance functional outcomes.
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Affiliation(s)
- Nicole M Sgromolo
- Department of Orthopaedic Surgery, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Peter C Rhee
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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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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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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Long Term Follow Up of a Vascularized Osteocutaneous Free Flap for Reconstruction in Charcot Neuroarthropathy: A Case Report. Ann Plast Surg 2018; 82:180-183. [PMID: 30557182 DOI: 10.1097/sap.0000000000001670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Vascularized osteocutaneous free flaps have seen increasing use in foot and ankle surgery for the repair of bony defects secondary to chronic nonunion, osteomyelitis, and fractures. One example is the Medial Femoral Condyle (MFC) Flap. The utility of the MFC flap for the repair of a bony defect in a diabetic patient, however, has yet to be explored. We report the long-term results of a case describing the use of an MFC flap to reconstruct an osseous defect resulting from first metatarsophalangeal joint resection in a diabetic patient.
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Donor-Site Morbidity and Functional Status following Medial Femoral Condyle Flap Harvest. Plast Reconstr Surg 2018; 142:734e-741e. [DOI: 10.1097/prs.0000000000004886] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mattos D, Ko JH, Iorio ML. Wrist arthrodesis with the medial femoral condyle flap: Outcomes of vascularized bone grafting for osteomyelitis. Microsurgery 2018; 39:32-38. [PMID: 30176071 DOI: 10.1002/micr.30368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 05/28/2018] [Accepted: 06/20/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Osteomyelitis of the wrist is rare but destructive. Subsequent bone defects often require vascularized bone for successful healing. Recent literature has pointed to the successful use of the medial femoral condylar (MFC) flap for difficult non-unions, yet it has not been specifically described for wrist fusion. We present our experience with this technique for limited and complete wrist arthrodesis. PATIENTS AND METHODS We reviewed 4 cases of radiocarpal bone loss from osteomyelitis. All cases utilized debridement of nonviable tissues, and at least 6 weeks of intravenous antibiotics, followed by vascularized bone grafting with a MFC flap. The flap was based on the horizontal periosteal branch of the descending geniculate artery, and utilized to directly bridge the bony defects following resection. RESULTS Three patients healed primarily, and 1 patient required secondary cancellous bone grafting to reach union. One patient required revision of the donor site closure. None of the patients had a recurrence of infection or other complications. Average follow up was 8.5 months after reconstruction. Average time to union was 11.5 weeks. Three patients demonstrated full composite fist, and 1 patient had incomplete finger range of motion following several flexor and extensor tendon grafts. CONCLUSIONS These cases illustrate the use of the MFC in wrist arthrodesis after osteomyelitis defects. In all cases, there was complete union in a short time, no recurrence of infection, and low donor-site morbidity.
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Affiliation(s)
- David Mattos
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jason H Ko
- Division of Plastic and Reconstructive Surgery, Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew L Iorio
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Division of Plastic and Reconstructive Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colorado
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Kawarai Y, Nakamura J, Suzuki T, Hagiwara S, Miura M, Ohtori S. Anatomical Features of the Descending Genicular Artery to Facilitate Surgical Exposure for the Subvastus Approach-A Cadaveric Study. J Arthroplasty 2018; 33:2647-2651. [PMID: 29656968 DOI: 10.1016/j.arth.2018.03.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/09/2018] [Accepted: 03/17/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this cadaveric study was to clarify the proximal limit for the subvastus approach (SVA) in total knee arthroplasty to decrease potential vascular injury. METHODS Seventy embalmed knees underwent a modified SVA using a 14-cm oblique medial incision. Anatomical features of the descending genicular artery (DGA) were investigated with regard to variation, distance of the vessels from surgical landmarks, and sex differences. RESULTS The DGA was identified in 62 knees (89%), while it was absent in 8 knees (11%); in the latter, the articular, saphenous, and muscular branches arose separately from the femoral artery. The mean distances from the tibial tuberosity and medial joint line to the origin of the DGA were 15.5 ± 1.6 cm and 12.6 ± 1.6 cm, respectively. Both distances were significantly longer in males than in females (P < .01, respectively). A strong positive correlation was found between the distance from the tibial tuberosity to the origin of the DGA and the distance from the medial joint line to the origin of the DGA (Spearman's correlation coefficient, R2 = 0.72, P < .01). A weak positive correlation was found between the distance from the tibial tuberosity to the origin of the DGA and lower leg length (R2 = 0.13, P < .01). No vascular injuries were observed in this surgical exposure. CONCLUSION The DGA showed several variations and was absent 11% of the time. An oblique medial incision within 14 cm from the tibial tuberosity followed by arthrotomy is considered a safe zone for the SVA.
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Affiliation(s)
- Yuya Kawarai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| | - Michiaki Miura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
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Versatility of the Medial Femoral Condyle Flap for Extremity Reconstruction and Identification of Risk Factors for Nonunion, Delayed Time to Union, and Complications. Ann Plast Surg 2018; 80:364-372. [DOI: 10.1097/sap.0000000000001332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Morsy M, Sur YJ, Akdag O, Eisa A, El-Gammal TA, Lachman N, Moran SL. Anatomic and high-resolution computed tomographic angiography study of the lateral femoral condyle flap: Implications for surgical dissection. J Plast Reconstr Aesthet Surg 2018; 71:33-43. [DOI: 10.1016/j.bjps.2017.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/17/2017] [Accepted: 08/06/2017] [Indexed: 11/26/2022]
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Guzzini M, Lanzetti RM, Perugia D, Lupariello D, Vadalà A, Guidi M, Civitenga C, Ferretti A. The treatment of long bones nonunions of upper limb with microsurgical cortico-periosteal free flap. Injury 2017; 48 Suppl 3:S66-S70. [PMID: 29025613 DOI: 10.1016/s0020-1383(17)30661-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Medial condyle corticoperiosteal flap is an emerging option for the treatment of upper limb non-infected nonunions. The hypothesis of our study is that corticoperiosteal flap could be an effective and safe procedure for the treatment of upper limb non-infected nonunions, evaluating radiographic and clinical outcome. METHODS We enrolled 14 patients who underwent vascularized medial femoral condyle corticoperiosteal free flaps from January 2011 to December 2014. All patients were clinically evaluated (VAS, DASH) before surgery and at 6 and 12 months post surgery. The radiographic evaluation was performed every 30 days until the complete healing and at 12-month follow-up. We also recorded the range of motion pre and post surgery at the donor site. RESULTS All nonunion sites healed primarily at an average time period of 5.2 months ±1. Preoperative DASH score was 70 ± 15.6; at 6 month follow-up was 21.51 ± 10.63; at 12 month follow-up 18.0 ± 9.9. Preoperative VAS was 7.05 ± 2; at 6-month follow-up was 2.1 ± 2; at 12-month follow-up was 1.8 ± 1.16. Statistical analysis showed a significant difference (p <0.001) about the preoperative and the postoperative VAS and DASH evaluation both at 6 and 12-month follow-up, but we did not record any statistical difference between the 6-month and 12-month follow-up. At the donor site, the mean VAS score was 2 ± 2.1 at seven days post operatively. All patients restore the full ROM at 7 days post surgery. CONCLUSIONS Vascularized medial condyle corticoperiosteal free flap represents an effective and safe procedure for the treatment of upper limb nonunions.
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Affiliation(s)
- Matteo Guzzini
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy
| | - Riccardo Maria Lanzetti
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy
| | - Dario Perugia
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy
| | - Domenico Lupariello
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy..
| | - Antonio Vadalà
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy
| | - Marco Guidi
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy
| | - Carolina Civitenga
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy
| | - Andrea Ferretti
- Unit of Orthopedics and Traumatology, S. Andrea Hospital, "La Sapienza" University, Rome, Italy; Corresponding author at: Unit of Orthopedics and Traumatology, S. Andrea Hospital, Via grottarossa 1053, 00100, Rome, Italy
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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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Henry M. Vascularized Medial Femoral Condyle Bone Graft for Resistant Nonunion of the Distal Radius. J Hand Surg Asian Pac Vol 2017; 22:23-28. [DOI: 10.1142/s0218810417500046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Nonunion involving the metaphyseal region of the distal radius is exceedingly rare, usually involving co-morbidity. Patients that have failed multiple prior conventional surgical interventions represent an even more difficult subset to treat; this investigation examined the utility of a specially designed free vascularized medial femoral condyle flap consisting of a central structural block graft with an extended corticoperiosteal sleeve to wrap around the junctions. Methods: Six patients (5 males, 1 female) with a mean age of 52 years had failed to achieve union involving the distal radius metaphysis after a mean of 3.7 prior surgeries occurring over a mean period of 24 months. Comorbidities included smoking, alcoholism, chronic nutritional deficiency, and prior osteomyelitis. The unique descending genicular artery medial femoral condyle flap designed to address these patients consisted of a central structural block graft in continuity with an extended corticoperiosteal sleeve. The structural block filled the bone defect, and the corticoperiosteal sleeve wrapped around the bone junctions and the neighboring bone margins. The mean flap size was 5.3 (+/- 1.3) cm long by 4.5 (+/- 0.9) cm wide. Pre-operative to post-operative DASH scores were compared using the paired student’ s t-test, with p < 0.05. Results: All flaps achieved union at a mean of 6.8 (+/- 2.1) weeks following surgery, using the criteria of bridging trabeculae on all 3 radiographs: coronal, sagittal, and oblique. The mean pre-operative DASH score of 63 (+/- 10) was statistically significantly different compared to the mean post-operative DASH score of 18 (+/- 8). Conclusions: With few alternative solutions able to address this unique and difficult problem, the structural block of vascularized bone with the extended corticoperiosteal sleeve proved able to achieve a union that had failed multiple previous attempts and able to resist reactivation of infection, in a challenging group of patients with comorbidities.
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Affiliation(s)
- Mark Henry
- Hand and Wrist Center of Houston, Houston, USA
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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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Weitgasser L, Cotofana S, Winkler M, Buerger H, Jamnig D, Anderhuber F, Gaggl A. Detailed vascular anatomy of the medial femoral condyle and the significance of its use as a free flap. J Plast Reconstr Aesthet Surg 2016; 69:1683-1689. [DOI: 10.1016/j.bjps.2016.09.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/09/2016] [Accepted: 09/27/2016] [Indexed: 11/25/2022]
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Kalb K. Freies gefäßgestieltes Femurknochentransplantat bei Skaphoidpseudarthrose. DER ORTHOPADE 2016; 45:966-973. [DOI: 10.1007/s00132-016-3334-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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