Abstract
A unique clinical problem exists when the majority of distal bone stock in a digit
is destroyed by osteomyelitis, leaving a residual soft tissue envelope with tenuous,
random perfusion surrounding a nidus of scar tissue. Pulp pinch is lost in the absence
of bony support, and limited options exist. Apart from toe transfer or revision amputation
with shortening, non-vascularized bone grafting inside the residual soft tissue envelope
risks graft resorption and reactivation of infection. The purpose of this investigation
was to evaluate the clinical outcomes of free vascularized medial femoral condyle
structural bone flaps to restore lost pulp pinch in such cases. Nine patients (8 males,
1 female) with a mean age of 43 years sustained extensive terminal bone loss near
digital tips following osteomyelitis. The mean length of bone defect was 28 mm (±
8.4). The patients were reconstructed at a mean of 12 weeks from initial trauma/infection,
having undergone a mean of two prior surgeries. A structural block of vascularized
bone from the medial femoral condyle replaced the missing bone at the digital tip
defect, temporarily fixed with K-wires. The bone flap was encased by the residual
soft tissue envelope after removing scar tissue from the prior trauma and infection.
All bone flaps incorporated fully, restoring pulp pinch function to the respective
digits with a mean time to union of 8.6 (± 2.1) weeks; range 6–11 weeks. With few
alternative solutions able to address this unique and difficult problem, the structural
block of vascularized bone proved able to resist resorption, nonunion, and reactivation
of infection; the problems normally encountered under this scenario.
Keywords
Bone - Medial - Femoral - Condyle - Flap
