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

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 Scaphoid Nonunion With Poor Prognostic Factors

Hand ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Tahseen Chaudhry ◽  
Lauren Uppal ◽  
Dominic Power ◽  
Michael Craigen ◽  
Simon Tan
Keyword(s):  
Prognostic Factors ◽  
Bone Graft ◽  
Femoral Condyle ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Vascularized Bone Graft ◽  
Union Rate ◽  
Poor Prognostic Factor ◽  
Low Incidence ◽  
Vascularized Bone

Background: To report on the results of free medial femoral condyle (MFC) vascularized bone graft for scaphoid nonunions with 1 or more poor prognostic factors. Methods: We have used the free MFC vascularized bone graft for scaphoid nonunions that have 1 or more factors associated with a poor prognosis. These were, a delay in presentation of over 5 years, a proximal pole nonunion, the presence of avascular necrosis (AVN), or previous nonunion surgery. We used this technique on 20 patients over a 4.5-year period. Results: Our overall union rate was 88.5% (17 of 19 patients), with 1 patient failing to attend for follow-up. Our mean union time was 7 months (2-18). All patients had at least 1 poor prognostic factor and over half had 2 or more. Of those with AVN with or without other factors, the union rate was 85% (11 of 13). There were 2 donor site complications that required a further procedure and 2 patients with residual wrist pain that required a scapho-trapezio-trapezoid joint fusion and a radial styloidectomy, respectively. Both nonunions were offered further surgery, and 1 elected to undergo successful revision surgery. Conclusions: Overall, this technique showed good results, in a subgroup of patients that typically have poorer outcomes, with a low incidence of donor site morbidity. Our union rate compares favorably with other techniques for this difficult subset of patients with 1 or more poor prognostic factors, although results are clearly not as good as those of studies using the MFC graft for all scaphoid nonunions. We continue to reserve this technique for nonunions with 1 or more poor prognostic factors, and we believe that this technique should at least be considered in these patients.

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

scholarly journals A Study of the Donor Site Morbidity of the Medial Femoral Condyle Flap

2018 ◽  
Vol 43 (9) ◽  
pp. S50
Author(s):  
Mohamed Morsy ◽  
Mohamed Diya Sabbagh ◽  
Alexander Y. Shin ◽  
Allen T. Bishop ◽  
Steven L. Moran ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Medial Femoral Condyle

Corticoperiosteal medial femoral condyle flap for recalcitrant nonunion in ankle and foot: Outcomes and radiological evaluation of donor site morbidity

2020 ◽  
Vol 26 (8) ◽  
pp. 918-923
Author(s):  
Olga Politikou ◽  
Stephan Wirth ◽  
Thomas Giesen ◽  
Roman Guggenberger ◽  
Pietro Giovanoli ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Medial Femoral Condyle ◽  
Radiological Evaluation ◽  
Ankle And Foot

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.

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 Bifocal Distraction to Regenerate Segmental Mandibular Defects Using a Custom Made Device: A Report of Two Cases

2010 ◽  
Vol 3 (2) ◽  
pp. 97-104 ◽  
Author(s):  
Sriram Krishnan ◽  
Ramkumar Subramaniam
Keyword(s):  
Paradigm Shift ◽  
Operative Time ◽  
Donor Site ◽  
Bone Grafts ◽  
Donor Site Morbidity ◽  
Custom Made ◽  
Ablative Surgery ◽  
Special Expertise ◽  
Temporary Stabilization ◽  
Vascularized Bone

Background and objective: Mandibular reconstruction following tumor ablative surgery had been a challenge. It has gone through days of temporary stabilization with k-wire, stainless steel reconstruction plate to avascularized and vascularized bone grafts with varying degree of success and failure. Reconstruction with vascularized bone grafts, though most definitive, requires special expertise, expensive equipment, and long operative time. It also produces donor site morbidity and requires a significant learning curve. With the development of transport distraction techniques there has been a paradigm shift from “reconstructive” to “regenerative” surgery. The objective of this study was to identify the feasibility of an internal device for reconstruction of extensive mandibular defects. Methods and material: This article is to highlight a process of attempted mandibular regeneration in two cases using an indigenously designed distractor device. In individuals with extensive post ablative mandibular defects who were unwilling to have a secondary surgical site or were medically unfit for a long reconstructive procedure, the distraction technique can be used to reconstruct the lost mandibular structures. Conclusion: A satisfactory amount of regenerate was achieved using a bifocal distraction osteogenesis technique for extensive defects of the mandible. The custom made device which was used for this purpose was moderately satisfactory and requires further evaluation and refinement.

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