The arterial anatomy of the medial femoral condyle and its clinical implications

2010 ◽  
Vol 35 (7) ◽  
pp. 569-574 ◽  
Author(s):  
H. Yamamoto ◽  
D. B. Jones ◽  
S. L. Moran ◽  
A. T. Bishop ◽  
A. Y. Shin
Keyword(s):  
Articular Surface ◽  
Femoral Condyle ◽  
Bone Grafts ◽  
Medial Femoral Condyle ◽  
Lower Limbs ◽  
Clinical Implications ◽  
Internal Diameter ◽  
Genicular Artery ◽  
Arterial Anatomy ◽  
Vascularized Bone

The success of vascularized bone grafts from the medial femoral condyle in various clinical applications has sparked renewed interest in the microvascular anatomy of this region. This study describes the arterial supply of the distal medial femoral condyle and its implications in harvesting vascularized bone grafts. The location, branching pattern, internal diameter, and distribution of perforators of the descending genicular artery and superior medial genicular artery in 19 fresh cadaveric lower limbs were recorded. The descending genicular artery was present in 89% and the superior medial genicular artery was present in 100% of specimens with average distances proximal to the articular surface of 13.7 cm and 5.2 cm, respectively. The average number of perforating vessels was greatest in the posterior distal quadrant of the condyle. The blood supply of the medial femoral condyle is plentiful and consistent making it a useful source for free vascularized bone grafts.

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

scholarly journals Medial Femoral Condyle Flap Reconstruction of a Maxillary Defect with a 3D Printing Template

2017 ◽  
Vol 02 (01) ◽  
pp. e63-e68
Author(s):  
Erin Taylor ◽  
Winona Wu ◽  
Parisa Kamali ◽  
Nalton Ferraro ◽  
Joseph Upton ◽  
...  
Keyword(s):  
3D Printing ◽  
Femoral Condyle ◽  
Three Dimensional ◽  
Medial Femoral Condyle ◽  
Printing Technology ◽  
3D Printing Technology ◽  
Maxillary Defect ◽  
3D Ct Scan ◽  
Genicular Artery ◽  
Vascularized Bone

Background The medial femoral condyle (MFC) flap is a well-vascularized corticocancellous flap based off the descending genicular artery that can be used to reconstruct difficult bony nonunions. Although frequently used in reconstruction of extremity defects, the MFC flap is rarely used in maxillofacial reconstruction. Methods We present a case example of an MFC vascularized corticocancellous free flap for reconstruction of an ameloblastoma maxillary defect. Additionally, we describe our use of a three-dimensional (3D) template to create an intraoperative osteotomy model for contouring the MFC flap. Results Preoperative 3D printing of the maxillary defect and design of a methylmethacrylate template enabled the precise and rapid contouring of a well-vascularized bone flap. Postoperative 3D CT scan demonstrated satisfactory positioning of the MFC flap within the maxilla. Conclusion The 3D printing technology continues to advance craniofacial reconstruction and allows for the efficient and precise creation of vascularized bone flaps. The MFC vascularized flap has the potential of becoming a workhorse flap in maxillary defect reconstruction alongside the use of 3D printing technology.

scholarly journals The Efficacy of Vascularized Bone Grafts in the Treatment of Scaphoid Nonunions and Kienbock Disease: A Systematic Review in 917 Patients

2018 ◽  
Vol 11 (01) ◽  
pp. 006-013 ◽  
Author(s):  
Andreas Tsantes ◽  
Dimitrios Papadopoulos ◽  
Ioannis Gelalis ◽  
Marios Vekris ◽  
Emilios Pakos ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Bone Grafts ◽  
Medial Femoral Condyle ◽  
Scaphoid Nonunion ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Artery Graft ◽  
Consolidation Rate ◽  
Vascularized Bone ◽  
Kienbock’S Disease

Abstract Background Vascularized bone grafts have become one of the first treatment options for scaphoid nonunions and Kienböck's disease. The aim of this study is to review the current body of the literature regarding the use of four vascularized bone grafts (1,2 ICSRA [1,2 intercompartmental supraretinacular artery] graft, 4+5 ECA [4+5 extracompartmental artery] graft, volar radial graft, and free medial femoral condyle graft) in these pathologies. Patients and Methods A search on MEDLINE and Google Scholar was performed. Exclusion criteria included language other than English, studies with no full text available, case reports, letters, editorials, and review articles. The primary outcomes included consolidation rate of the grafts and time to union regarding scaphoid nonunion, as well as the clinical outcomes (pain, grip strength, range of motion), revascularization of the lunate, and progression of the disease regarding Kienböck's disease. Results A total of 37 articles were included in the study enrolling 917 patients. Regarding scaphoid nonunion, the consolidation rate was 86.3% for the 1,2 ICSRA graft, 93.9% for the volar radial bone graft, and 88.8% for the free medial femoral condyle graft. In patients with Kienböck's disease, progression of the disease was observed in 13% of patients, and grip strength and pain were substantially improved whereas range of motion did not demonstrate statistically significant improvement (p < 0.05). Conclusion Vascularized bone grafts yield successful outcomes in patients with scaphoid nonunions demonstrating a high union rate. In patients with Kienböck's disease, vascularized grafts lead to revascularization of the lunate in most of the cases with concomitant improvement of the clinical parameters.

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 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.

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

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