Donorsite defect of medial femoral condyle corticoperiostal flap in the treatment of lower limb infected nonunions

2020 ◽  
Author(s):  
Matteo Guzzini ◽  
Leopoldo Arioli ◽  
Clelia Rugiero ◽  
Marco Rossini ◽  
Giuseppe Argento ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bone Healing ◽  
Soft Tissues ◽  
Femoral Condyle ◽  
Donor Site ◽  
Medial Femoral Condyle ◽  
Lower Limbs ◽  
Femoral Diaphysis ◽  
Recipient Site ◽  
Non Union

Abstract Backgrounds Chronic osteomyelitis is a major challenge in orthopaedic surgery; it is the result of open fracture, periprosthetic infection and septic arthritis. Osteomyelitis leads to fracture nonunion. The treatment of bone infection and infected nonunion consists primarily of the complete removal of infected and avascular bone and soft tissue from the surgical site, followed by local and systemic pathogen-specific antibiotic therapy and temporary stabilisation, but may lead to massive skeletal and soft tissue defects. The use of free or pedicled vascularised bone transfers and callus distraction techniques (bone transport) has been recommended for large bone defects. The aim of this study is to evaluate the results of patients affected by infected non-unions of the lower limbs, treated with a corticoperiosteal flap from the medial femoral condyle and to investigate the donor site morbidity of this flap. Materials and methods The patients were 11 males (average age of 45.6 years), who presented a nonunion of the tibial diaphysis in 7 cases and non-union of femoral diaphysis in 4 cases, treated with free or pedicled corticoperiosteal flap. In all patients, surgical debridement was performed before the flap of infected bone and soft tissues that would not contribute to wound healing. Clinical and radiographic evaluations of the recipient site were performed. Preoperative and postoperative X-ray and MRI scans after the 3-year follow-up of the donor site were performed, in order to observe possible bone restoration and any complications. Results The patients reported complete clinical and radiographic bone healing in 90.9 % of cases. As regards donor site, there were no differences between the medial femoral donor condyle compared to the contralateral site, due to complete regeneration of donor site bone. MRI investigation showed complete restoration of the donor site with vascularised bone in all patients. Conclusions Our results suggest that the use of bone flaps for the treatment of infected non-unions is an effective procedure, that must be performed after accurate debridement of the non-union site. The corticoperiosteal flap seems to have few morbidities on the donor site and a high percentage of successful bone healing.

scholarly journals Medial femoral condyle vascularised corticoperiosteal graft: A suitable choice for scaphoid non-union

2017 ◽  
Vol 50 (02) ◽  
pp. 138-147 ◽  
Author(s):  
Samir Kumta ◽  
Sudhir Warrier ◽  
Leena Jain ◽  
Rani Ummal ◽  
Manik Menezes ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Hand Function ◽  
Scaphoid Fracture ◽  
Full Range ◽  
Donor Site ◽  
Optimal Solution ◽  
Difficult Problem ◽  
Medial Femoral Condyle ◽  
Osteogenic Potential ◽  
Non Union

ABSTRACT Introduction: Scaphoid fractures are not very common and frequently remain undiagnosed, presenting in non-union and persistent wrist pain. Options for scaphoid fracture treatment have been described over several decades, however, none with an optimal solution to achieve union along with good hand function. We describe here, the use of vascularised corticoperiosteal bone grafts from the medial femoral condyle (MFC) as a solution for the difficult problem of scaphoid fracture non-union. Materials and Methods: This series has 11 patients with non-union following a scaphoid fracture treated over 18 months ranging from January 2014 to January 2016 using a vascularised corticoperiosteal graft from the MFC. Bone graft fixation was done using K-wires and anastomosis was done with the radial vessels. Results: There were no cases of flap loss. Time of union was an average 3 months. All patients had a full range of movements. Discussion: MFC is an ideal site for harvesting vascularised corticoperiosteal grafts providing a large surface of tissue supplied by a rich periosteal plexus from the descending genicular artery. No significant donor site morbidities have been reported in any series in the past. The well-defined anatomy helps in a rather simple dissection. Corticoperiosteal grafts have a high osteogenic potential and hence, this vascularised graft seems ideal for small bone non-unions. Conclusion: Thin, pliable and highly vascularised corticocancellous grafts can be obtained from the MFC as an optimal treatment option for scaphoid non-unions.

Vascular and Bone Regeneration of the Donor Site After Corticoperiosteal Flap From the Medial Femoral Condyle

Hand ◽  
2020 ◽  
pp. 155894472093029
Author(s):  
Matteo Guzzini ◽  
Domenico Lupariello ◽  
Giuseppe Argento ◽  
Leopoldo Arioli ◽  
Andrea Ferretti
Keyword(s):  
Magnetic Resonance ◽  
Blood Supply ◽  
Upper Limb ◽  
Femoral Condyle ◽  
Donor Site ◽  
Medial Femoral Condyle ◽  
Recipient Site ◽  
Medial Condyle ◽  
Genicular Artery

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.

Donor-Site Morbidity and Functional Status following Medial Femoral Condyle Flap Harvest

2018 ◽  
Vol 142 (5) ◽  
pp. 734e-741e ◽  
Author(s):  
Ghassan Mehio ◽  
Mohamed Morsy ◽  
Cenk Cayci ◽  
M. Diya Sabbagh ◽  
Alexander Y. Shin ◽  
...  
Keyword(s):  
Functional Status ◽  
Femoral Condyle ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Medial Femoral Condyle

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 Clinical and radiological results of the vascularized medial femoral condyle graft for scaphoid non-union

2020 ◽  
Vol 140 (6) ◽  
pp. 835-842 ◽  
Author(s):  
Marco Keller ◽  
Tobias Kastenberger ◽  
Anizar Faizi Anoar ◽  
Peter Kaiser ◽  
Gernot Schmidle ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Non Union ◽  
Radiological Results ◽  
Clinical And Radiological Results

Free vascularized medial femoral condyle corticoperiosteal flap with non-vascularized iliac crest graft for the treatment of recalcitrant clavicle non-union

2020 ◽  
Vol 73 (7) ◽  
pp. 1232-1238
Author(s):  
Charlotte Jaloux ◽  
Quentin Bettex ◽  
Michel Levadoux ◽  
Alexandre Cerlier ◽  
Aurélie Iniesta ◽  
...  
Keyword(s):  
Iliac Crest ◽  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Iliac Crest Graft ◽  
Non Union

scholarly journals Treatment of a Femur Nonunion with Microsurgical Corticoperiosteal Pedicled Flap from the Medial Femoral Condyle

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Matteo Guzzini ◽  
Cosma Calderaro ◽  
Marco Guidi ◽  
Carolina Civitenga ◽  
Germano Ferri ◽  
...  
Keyword(s):  
Distal Femur ◽  
Femoral Condyle ◽  
Weight Bearing ◽  
Donor Site ◽  
Pedicled Flap ◽  
Medial Femoral Condyle ◽  
Full Weight Bearing ◽  
Genicular Artery ◽  
Reconstruction Of Bone Defects

Introduction. The vascularized corticoperiosteal flap is harvested from the medial femoral condyle and it is nourished by the articular branch of the descending genicular artery and the superomedial genicular artery. This flap is usually harvested as a free flap for the reconstruction of bone defects at forearm, distal radius, carpus, hand, and recently at lower limb too.Case Report. A 50-year-old Caucasian man referred to our department for hypertrophic nonunion of the distal femur, refractory to the conservative treatments. The first surgical choice was the revision of the nail and the bone reconstruction with a corticoperiosteal pedicled flap from the medial femoral condyle. We considered union to have occurred 3.5 months after surgery when radiographs showed bridging of at least three of the four bony cortices and clinically the patient was able to walk with full weight bearing without any pain. At the last follow-up (25 months), the patient was completely satisfied with the procedure.Discussion. The corticoperiosteal flap allows a faster healing of fractures with a minimal morbidity at the donor site. We suggest that the corticoperiosteal pedicled flap graft is a reliable and effective treatment for distal femur nonunion.

Donor site morbidity of vascularized bone grafts from the medial femoral condyle for osseous revascularization

Microsurgery ◽  
2020 ◽  
Vol 40 (2) ◽  
pp. 104-109 ◽  
Author(s):  
Victoria Franziska Struckmann ◽  
Giuseppe Rusignuolo ◽  
Leila Harhaus ◽  
Ursula Trinler ◽  
Berthold Bickert ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Donor Site ◽  
Bone Grafts ◽  
Donor Site Morbidity ◽  
Medial Femoral Condyle ◽  
Vascularized Bone

Medial Femoral Condyle Flap Donor-Site Morbidity

2013 ◽  
Vol 131 (3) ◽  
pp. 357e-362e ◽  
Author(s):  
Samir S. Rao ◽  
Carlton C. Sexton ◽  
James P. Higgins
Keyword(s):  
Femoral Condyle ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Medial Femoral Condyle
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