The Anterolateral Thigh-Medial Femoral Condyle Chimeric Flow-through Flap for Posttraumatic Wrist Arthrodesis

Complex reconstruction of the clavicle with a prefabricated medial femur condyle chimeric flap including a superficial circumflex iliac artery perforator flap: A case report

The medial femur condyle (MFC) cortico-periosteal flap is a popular flap for bone reconstruction. The use of a chimeric version of this flap with a skin island has been described, but anatomical arterial variation can occur that prevent its harvest. Furthermore, the donor area of the skin paddle has been debated as poor because of the scarring in a visible area and because of the difficulty in obtaining pliable thin skin. We present a fabricated chimeric MFC cortico-periosteal flap joined with a superficial inferior epigastric perforator (SCIP) flap to reconstruct and augment a sclerotic and insufficient small clavicula with the skin paddle acting as a monitor and as a substitute for the overlying skin. A 52-year-old female patient had a history of multiple refractures of the right hypoplastic clavicle with a diameter of 7 mm, resulting in a sclerotic bone with a fibrotic scar. The reconstruction was done in one surgical session using a cortico-periosteal flap from the left medial condyle and a thin SCIP flap from the left groin. The area of the clavicle to be reconstructed was 3 cm, and the direct overlying skin (approximately 6 × 3 cm) was severely scarred and painful. The MFC flap was 5 × 4 cm, while the SCIP flap was 7 × 3.5 cm. The SCIP flap artery was anastomosed on the table end-to-side to the descending genicular (DG) artery of the MFC, and the vein was anastomosed end-to-end to a comitans vein of the DG artery. The flap fully survived after an initial congestion. At 12 months, we observed a satisfactory reconstruction of the clavicle with an enhanced diameter of 12 mm. The patient recovered full function of the shoulder with no pain. Using a fabricated chimeric flap composed of a medial femoral condyle and a superficial circumflex artery perforator flap may be an additional option for tailored reconstruction of complex osteo-cutaneous defect of clavicle.

The Medial Femoral Condyle Flap: A Novel Versatile Tool for Complex Microvascular Maxillofacial Reconstruction

SUMMARY

The medial femoral condyle flap is well-described for reconstruction of small bone defects of the upper and lower extremities. There are limited case reports of its use in other anatomic sites, particularly for reconstruction of complex head and neck defects. In the setting of previous radiation and contaminated fields, vascularized bone is generally preferred to bone grafts, cadaveric allografts, or synthetic implants. The authors present a case series of complex craniofacial defects involving the midface that were reconstructed using medial femoral condyle flaps, focusing on the type of defect and lessons learned from their early experience to promote awareness of this flap among microsurgeons, who may wish to consider the potential of this flap and incorporate its use into their armamentarium.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Vacuum sealing drainage combined with free anterolateral femoral skin flap grafting in 16 cases of pediatric soft tissue damage to the foot and ankle

BACKGROUND

To investigate the clinical experience and discuss the use of vacuum sealing drainage (VSD) combined with free anterolateral femoral flap grafting to treat pediatric foot and ankle soft tissue traumas.

METHODS

This was a retrospective analysis of 16 pediatric patients with foot and ankle soft tissue traumas treated with free anterolateral femoral flap grafting from January 2015 to January 2018. After successful debridement and VSD, the clinical efficacy of the procedure was evaluated by observing parameters such as the color, shape, and texture of the flap on the receptor site.

RESULTS

All patients were followed up for 23-32 months after surgery. Of the 16 patients, six had a flat flap appearance, while the remaining ten patients required flap repair surgery 6-9 months after the procedure. Eight of these ten patients had a satisfactory repair, and the remaining two patients had further repair surgery 9-10 months after the flap grafting. The postoperative results of all patients were satisfactory; no local infection, good flap survival, soft texture, glossy elasticity, and flat appearance. Statistical results showed only one case of local necrosis at the distal end of the flap, and the wound healed at stage II after redebridement and dressing change.

CONCLUSIONS

VSD combined with free anterolateral femoral flap grafting is an easy and reliable operation with a good prognosis and excellent clinical utility and feasibility for treating pediatric patients with foot and ankle soft tissue traumas.