Free Medial Femoral Condyle Vascularized Bone Grafting for Scaphoid Nonunions with Proximal Pole Avascular Necrosis and Carpal Collapse

2012 ◽  
Vol 22 (3) ◽  
pp. 159-166 ◽  
Author(s):  
Peter C. Rhee ◽  
David B. Jones ◽  
Allen T. Bishop ◽  
Alexander Y. Shin
Keyword(s):  
Avascular Necrosis ◽  
Bone Grafting ◽  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Proximal Pole ◽  
Carpal Collapse ◽  
Vascularized Bone

Primary medial femoral condyle vascularized bone graft for scaphoid nonunions with carpal collapse and proximal pole avascular necrosis

2018 ◽  
Vol 44 (6) ◽  
pp. 600-606 ◽  
Author(s):  
Kathleen M. Kollitz ◽  
Nicholas Pulos ◽  
Allen T. Bishop ◽  
Alexander Y. Shin
Keyword(s):  
Bone Graft ◽  
Avascular Necrosis ◽  
Femoral Condyle ◽  
Primary Treatment ◽  
Medial Femoral Condyle ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Carpal Collapse ◽  
Time From Injury ◽  
Vascularized Bone

This study aimed to determine the outcome of free vascularized medial femoral condyle bone grafts in the primary treatment of scaphoid nonunions with scaphoid foreshortening or carpal collapse and intraoperatively documented avascular necrosis. Thirty-two patients (28 male, four female) met the inclusion criteria. Median time from injury to surgery was 70 weeks. Thirty of 32 patients healed at a median of 12 weeks. There was significant improvement from preoperative to postoperative lateral intrascaphoid angle, scapholunate angle, and radiolunate angle. Two scaphoids failed to unite; one patient underwent scaphoidectomy and four-corner fusion 15 months postoperatively after suffering a subsequent injury. Another patient underwent 1,2-intercompartmental supraretinacular artery-based vascularized bone grafting at 4 months postoperatively and then scaphoid excision with four-corner fusion 4 years later. The free vascularized medial femoral condyle bone graft restores scaphoid vascularity and architecture while promoting union in a subset of scaphoid nonunions that has historically been a clinical challenge. Level of evidence: IV

scholarly journals Bone Grafting for Scaphoid Nonunions: Is Free Vascularized Bone Grafting Superior for Scaphoid Nonunion?

Hand ◽  
2017 ◽  
Vol 14 (2) ◽  
pp. 217-222 ◽  
Author(s):  
William R. Aibinder ◽  
Eric R. Wagner ◽  
Allen T. Bishop ◽  
Alexander Y. Shin
Keyword(s):  
Range Of Motion ◽  
Bone Grafting ◽  
Femoral Condyle ◽  
Iliac Crest Bone Graft ◽  
Union Rate ◽  
Carpal Collapse ◽  
Significant Difference ◽  
Male Patients ◽  
Mean Time ◽  
Vascularized Bone

Background: Nonvascularized bone grafting (NVBG) and vascularized bone grafts (VBGs) have been used to treat scaphoid nonunions. A comparison of a single institution’ s experience using structural iliac crest bone graft (ICBG), 1,2-intercompartmental supraretinacular artery (1,2-ICSRA), and medial femoral condyle (MFC) grafts to treat scaphoid nonunions was undertaken. Methods: Thirty-one patients underwent ICBG, 33 patients underwent 1,2-ICSRA, and 45 patients underwent MFC grafting. Mean time to follow-up was 16 months (range, 2-153). Twenty-three percent used tobacco products. Mean age was 24 years (range, 11-66), with 86% male patients. Outcomes included union rate, time to healing, range of motion, complications, and reoperations. Results: Union rates and mean time to union were 71% and 19 weeks for the ICBG group, 79% and 26 weeks for the 1,2-ICSRA group, and 89% and 16 weeks for the MFC group, respectively. Failure of union was associated with tobacco use but not with age, gender, time from injury to surgery, or type of fixation. There was no significant difference between the groups regarding range of motion or strength. Conclusions: These findings demonstrate the need for careful patient selection. In patients with the most complicated scaphoid nonunions (avascular necrosis, carpal collapse, and previous surgeries), the MFC group had the highest union rate and fastest time to union. Patients with risk factors for failure should be counseled on the outcomes and possible need for salvage fusion surgery.

scholarly journals Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141988426 ◽  
Author(s):  
John T. Stranix ◽  
Merisa L. Piper ◽  
Said C. Azoury ◽  
Geoffrey Kozak ◽  
Oded Ben-Amotz ◽  
...  
Keyword(s):  
Free Flap ◽  
Femoral Condyle ◽  
Donor Site ◽  
Case Series ◽  
Medial Femoral Condyle ◽  
Flap Reconstruction ◽  
Foot And Ankle ◽  
Osseous Union ◽  
Vascularized Bone

Background: Complex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial femoral condyle (MFC) flaps provide vascularized periosteum, skin, and corticocancellous bone. Methods: A retrospective, single-institution cohort study of consecutive MFC flaps performed for complicated hindfoot reconstruction between 2013 and 2019 was reviewed. Radiologic follow-up assessed osseous union and clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Thirty MFC flaps were performed in 28 patients for complex hindfoot pathology. Twenty-seven flaps had adequate clinical and radiographic follow-up (mean 15.8 months). Results: The majority presented with avascular necrosis (83%) and failed prior operations (67%, mean 3.1). Most hindfoot procedures involved arthrodesis (n = 24, 80%); tibiotalocalcaneal (n = 11) and talonavicular (n = 7) most frequently. Mean osseous flap volume was 10.3 cm3 (range 1.7-18.4 cm3); one flap required takeback for venous congestion but no total flap losses occurred. Primary osseous union was initially achieved in 20 patients (74%, mean 217 days). Six flaps developed interface nonunion; 5 underwent revision arthrodesis and ultimately achieved union in 24/27 flaps (89%, mean 271 days). Risk factors for nonunion were body mass index (BMI) >30 ( P = .017) and prior arthrodesis ( P = .042). Mean AOFAS hindfoot scores increased significantly from 52.3 preoperatively to 70.7 postoperatively ( P < .001). Subscore analysis demonstrated significant improvement in postoperative pain scores from 14.2 to 27.3 out of 40 ( P < .001). Conclusion: The MFC free flap provided vascularized bone for complicated foot and ankle reconstruction with relatively low donor site morbidity, promising osseous union results, and improved functional outcomes. Level of Evidence: Level IV, retrospective case series.

scholarly journals Medial Femoral Condyle Periosteal Free Flap: A Novel Technique for the Treatment of Avascular Necrosis of the Talus

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0036
Author(s):  
Adam Saad ◽  
Megan L. Jimenez ◽  
Ryan Rogero ◽  
Sherif Saad ◽  
Brian S. Winters
Keyword(s):  
Surgical Technique ◽  
Avascular Necrosis ◽  
Short Form ◽  
Femoral Condyle ◽  
Case Series ◽  
Core Decompression ◽  
Lower Extremities ◽  
Medial Femoral Condyle ◽  
Functional Scores ◽  
Complex Procedure

Category: Hindfoot Introduction/Purpose: Avascular necrosis (AVN) of the talus is commonly caused by trauma and often requires surgical management. It is recommended that healthy patients, in pre-collapse stages, undergo joint preservation procedures. Good results have been published in patients in pre-collapse stages who undergo vascularized bone grafting. Although many graft options exist, more recently the medial femoral condyle (MFC) free vascularized graft has been introduced. This graft typically utilizes vascularized corticoperiosteal bone but can be modified to the use of solely periosteum, which theoretically decreases morbidity and operative time. There is limited research on the periosteal-only MFC flap to treat AVN of the talus. We present a case series and surgical technique utilizing a periosteal vascularized pedicle graft to teat AVN of the talus. Methods: A surgical technique is presented, in addition to a retrospective review of AVN of the talus of 6 lower extremities. Treatment included talus core decompression along with an ipsilateral medial femoral condyle free vascularized periosteal graft. All patients included were in the pre-collapse stage. Short-term clinical outcome measures of Foot & Ankle Ability Measure- Activities of Daily Living (FAAM-ADL) subscale, Short Form-12 (SF-12), and Visual Analog Scale (VAS) for pain were recorded for all patients post-operatively. Paired T-tests were used to compare pre- and post-operative functional scores. Post-operative MRIs were reviewed by a musculoskeletal radiologist. Results: The causes of AVN included trauma (2/6, 33%), sepsis (2/6, 33%), and idiopathic (2/6, 33%). Post-operative FAAM-ADL (P=0.004) and VAS (P=0.003) scores showed statistically significant improvement from pre-operative values at an average of 16.0 months (range, 6-28 months) after surgery. Additionally, all patients (100%) reported being “very satisfied” with their surgical outcome. There was 1 minor complication, with one patient reporting minimal paresthesias following surgery. Post-operative MRIs, taken at a mean of 12.7 months, demonstrated both resolution of marrow edema and soft tissue inflammation surrounding the areas of AVN and a lack of AVN progression in 100% of lower extremities, when compared to pre-operative MRIs. Conclusion: Medial femoral condyle free vascularized periosteal graft is a complex procedure which requires a team comprised of a foot & ankle surgeon and a plastic/hand surgeon familiar with microvascular surgery. This study shows promising initial results for the treatment of an extremely challenging diagnosis: AVN of the talus. Long-term, prospective studies are needed to confirm the findings presented in the current study.

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