Vasculature of a Medial Femoral Condyle Free Flap in Intact and Osteotomized Flaps:

Total Nasal Reconstruction: Advances in Free Tissue Transfer for Internal Lining and Structural Support

Total nasal reconstruction is a complex challenge due to the need to establish new internal lining, internal structural support, and external skin covering that is both functional and esthetic. The medial femoral condyle corticoperiosteal free flap represents an innovative option for restoration internal structure and internal nasal lining. When used in conjunction with a paramedian forehead flap, acceptable results in both function and esthetics can be achieved.

Expanding Indications of the Medial Femoral Condyle Free Flap: Systematic Review in Head and Neck Reconstruction

The medial femoral condyle free flap serves as an attractive reconstructive option for small- to intermediate-sized bony defects. It is commonly applied in the extremities with limited reports in the head and neck.

Methods

A systematic review of the literature was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results

Seventeen articles met inclusion criteria, yielding 166 cases for analysis, with a majority of the cohort from a single study (n = 107; 64.4%). However, all included studies represented novel reconstructive sites and surgical indications. Flap components were described in 157 cases; periosteum was used only in four cases (2.5%), whereas all others are composed of cortical bone combined with periosteum, cancellous bone, and/or cartilage (97.5%). Additionally, a skin island was used in 43 cases (25.9%). Flap measurements were reported in 51 cases, averaging 4.5 ± 2.7 cm in length. Seven cases listed skin island dimensions, averaging 20.2 ± 12.8 cm². The descending genicular artery was the primary pedicle employed (n = 162; 97.6%), while the superior medial genicular was used in the descending genicular artery's absence (n = 4; 2.4%). Descending genicular artery pedicle length from 15 reporting cases averaged 6.4 ± 1.2 cm. Successful reconstructions totaled 160 cases (96.4%). Recipient complications were seen in 16 cases (9.6%) with six constituting flap failures (3.6%). Donor site complications were minimal (n = 6; 3.6%); however, this included one major complication of femoral shaft fracture.

Conclusion

The medial femoral condyle free flap is an effective reconstructive option for the head and neck due to its versatile nature, low complication profile at both recipient and donor site, ease of harvest, and two-team approach.

Metacarpal reconstruction with a medial femoral condyle flap based on a 3D-printed model: a case report

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)

Topographic Anatomy and Clinical Impact of Vascular Foramen on the Trochlear Groove of Adult Human Dry Femora

Objective

In this study, we aimed to assess the topographic anatomy and clinical impact of the vascular foramen on the trochlear groove of adult human dry femora.

Materials and methods

The incidence, shape, size, and location of the foramen present on the trochlear groove of the distal femur were studied using 33 adult human dry femora of unknown age and gender at the Department of Anatomy at Nowshera Medical College, Nowshera, Pakistan. Using a divider and scale, the incidence and structure of the vascular foramen in the trochlear groove were examined and its position in relation to the trochlear groove's upper and lower articulating edges was recorded.

Results

Out of 33 femora, 20 (60.6%) were right-sided and 13 (39.4%) were left-sided. All the foramina had round morphometry. In each of the 33 adult human dry femora, 15 (45.5%) had a single trochlear vascular foramen. One solitary trochlear vascular foramen was found in eight (53.3%) of the left femora and seven (46.7%) of the right femora. The diameter of each trochlear vascular foramina was about 2.5-4.5 mm with a mean diameter of 3.5 mm. Trochlear groove upper margin and foramen were 1.75-2.5 cm apart, whereas the lower margin was 0.5-01 cm apart. On average, foramen was 2.2 cm away from the upper margin, and 0.8 cm away from the lower margin. In the midline, nine (60%) trochlear vascular foramina were found, with five (55.5%) resting on the trochlear groove lower margin, and four (44.5%) lying mid-way at varying places from the upper and lower margins. The left of the centerline had six (40%) of the trochlear vascular foramen, whereas no trochlear vascular foramen was seen on the right side of the midline.

Conclusions

Based on our findings, a significant segment of our population has trochlear vascular foramen present on the trochlear groove as the rate of occurrence of this was found to be 45.5%. The trochlear groove center has the most foramen, accounting for 60% of all the foramen.

Morphometry and Morphology of Vascular Foramen on the Trochlear Groove of the Distal Femur and Its Implications

Background and objective Nutrient foramina in supracondylar, medial condyle, lateral condyle, and intercondylar fossa have been described in the literature. The author of the present study observed a vascular foramen on the trochlear groove, which has not been previously reported in the literature. The aim of the study was to elaborate on the morphology, morphometry, and associated clinical implications of this foramen. Materials and methods Forty-five unpaired femora of unknown sex available in the Department of Anatomy at the Uttar Pradesh University of Medical Science (UPUMS), Saifai, India were observed to examine the incidence, shape, size, and location of the foramen on the trochlear groove of the distal femur. The incidence and shape were observed and its location in relation to the upper and lower articulating margin of the patella was recorded using a divider and scale. Results The trochlear foramen was observed in 25 femora, accounting for 55.6% of the total. The average diameter of the foramen was 4 mm. The average distance of the foramen from the upper patellar articulating surface was 2.4 cm and its distance from the lower margin was 0.7 cm. All the foramina were round in shape. The largest number of foramina were located in the midline, and seven foramina were located to the left of the midline of the trochlear groove. Conclusions The incidence of the trochlear foramen was 55.6%, meaning that more than half of the population possess this foramen on the trochlear groove. The maximum number of these foramen, amounting to 64%, were found in the midline of the trochlear groove. The morphologic and topographic knowledge of the trochlear foramen is essential for orthopedic surgeons during operative procedures in the region of the distal femur.

The Medial Femoral Condyle Free Flap for Reconstruction of Recalcitrant Defects in the Head and Neck

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.

3D Printing for scaphoid-reconstruction with medial femoral condyle flap

Three-dimensional (3D) printing has emerged as an innovative technology to derive a maximum benefit from high-resolution tomography images and virtual 3D reconstructions. The present study describes a novel technique using a 3D printed model for harvesting osteochondral medial femur condyle (MFC) flap to replace the proximal pole of the scaphoid in case of proximal avascular pole. MFC bone grafting has already proved to be reasonable surgical method for this indication. To refine this technique, we introduce a 3D model of the proximal scaphoid pole on a handlebar with anatomic orientation marks on its surface, which was virtually planned via 3D imaging and finally 3D printed. This 3D model was sterilized and facilitated several intraoperative steps, such as resecting the proximal pole, simulating the alignment of the future MFC flap, detecting the most feasible harvest site, reducing the donor site morbidity and precisely modeling the graft. In summary, 3D printing is an innovative, feasible technology to aid in various surgical steps while performing a MFC flap for posttraumatic avascular proximal scaphoid pole. It enhances the surgeon's perception of complex patient-specific pathologies and intraoperative accuracy. Especially, we emphasize the benefit of a handlebar on the 3D model, because it enormously improves its maneuverability and usability.

Mandibular Condyle Reconstruction With Fibula Free-Tissue Transfer: The Role of the Masseter Muscle

BACKGROUND

Free fibula flap is an option for primary restoration after disarticulation mandibular resection, though literature on technique refinements is scarce. The authors hypothesized that inset of the masseter, the key mandibular elevator muscle, at the reconstructed mandible may optimize functional recovery.

METHODS

All patients undergoing reconstruction of mandibulectomy-condylectomy defect (January 2009 to January 2014) by means of a fibular flap were prospectively studied. The neocondyle was formed by the distal portion of the fibula and placed directly into the glenoid fossa with preservation of the temporomandibular disc. The deep portion of the masseter was inset at the angle of the reconstructed mandible.Condylar position was postoperatively evaluated by panoramic radiographs. Patients self-evaluated speech, chewing, swallowing, and facial appearance.

RESULTS

Two patients had immediate and 3 delayed reconstruction involving condyle ramus body, in the study period. During a mean follow-up of 32 months, 4 patients had satisfactory occlusion, 1 patient had an open-bite deformity, but was able to masticate solid food and maintain an oral diet. Although no significant condyle dislocation was recorded, 2 patients had slight ipsilateral deviation on mouth opening. Nevertheless, cosmesis was satisfactory and all patients maintained intelligible speech. Functional score was 13.6 ± 1.14 and facial appearance score was 4 ± 0.7.

CONCLUSION

The free fibula transfers with direct seating of the fibula into the condylar fossa followed by masseter muscle reinsertion provides acceptable functional reconstruction of the mandibulectomy-condylectomy defect.