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DOI: 10.1055/s-0034-1390045
Free Vascularized Medial Femoral Condyle Corticocancellous Flap for Treatment of Challenging Upper Extremity Nonunions
Publication History
24 June 2014
02 July 2014
Publication Date:
29 September 2014 (online)
![](https://www.thieme-connect.de/media/jrm/201502/lookinside/thumbnails/10.1055-s-0034-1390045-1.jpg)
Abstract
Background Nonunions in the upper extremity are challenging for the reconstructive surgeon. The evolution of microsurgical techniques has allowed for the reliable use of free vascularized bone flaps.
Methods In a retrospective study, patients with challenging upper limb nonunions who underwent free vascularized corticocancellous flaps from the medial femoral condyle (MFC) were included. Patient demographics, surgical technique, and outcomes were evaluated.
Results Fifteen patients with nonunions of the upper extremity underwent free MFC corticocancellous flap reconstruction. The length of preoperative bone defects ranged from 0.8 to 3 cm, and the mean number of procedure prior to free MFC reconstruction was 1.5. Thirteen patients healed completely in an average of 15 weeks (range, 8–22 weeks). Two patients were lost to follow-up. Only one patient required additional surgery. Functional outcome measures such as Mayo, Disability of Arm, Shoulder, and Hand, and Constant–Murley scores all demonstrated improvement.
Conclusion The free vascularized MFC corticocancellous flap can be successfully used for challenging upper extremity nonunions and small bone defects.
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References
- 1 Rosen H. Treatment of nonunion: general principles. In: Chapman WM, , ed. Operative Orthopaedics. Philadelphia: Lippincott Raven; 1988: 489-509
- 2 Ring D, Allende C, Jafarnia K, Allende BT, Jupiter JB. Ununited diaphyseal forearm fractures with segmental defects: plate fixation and autogenous cancellous bone-grafting. J Bone Joint Surg Am 2004; 86-A (11) 2440-2445
- 3 Brinker MR. Non-unions: evaluation and treatment. In: Browner BD, Levine AM, Jupiter JB, , et al, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction. Philadelphia: WB Saunders; 2003: 507-604
- 4 Masquelet AC. Free vascularized corticoperiosteal grafts. Plast Reconstr Surg 1991; 88 (6) 1106
- 5 Goldberg VM, Shaffer JW, Field G, Davy DT. Biology of vascularized bone grafts. Orthop Clin North Am 1987; 18 (2) 197-205
- 6 Shaffer JW, Field GA, Goldberg VM, Davy DT. Fate of vascularized and nonvascularized autografts. Clin Orthop Relat Res 1985; (197) 32-43
- 7 Sanders R, Mayou BJ. A new vascularized bone graft transferred by microvascular anastomosis as a free flap. Br J Surg 1979; 66 (11) 787-788
- 8 Falder S, Sinclair JS, Rogers CA, Townsend PL. Long-term behaviour of the free vascularised fibula following reconstruction of large bony defects. Br J Plast Surg 2003; 56 (6) 571-584
- 9 Handschel J, Hassanyar H, Depprich RA , et al. Nonvascularized iliac bone grafts for mandibular reconstruction—requirements and limitations. In Vivo 2011; 25 (5) 795-799
- 10 Koshima I, Higaki H, Soeda S. Combined vascularized fibula and peroneal composite-flap transfer for severe heat-press injury of the forearm. Plast Reconstr Surg 1991; 88 (2) 338-341
- 11 Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft. Plast Reconstr Surg 1991; 87 (2) 290-298
- 12 Doi K, Oda T, Soo-Heong T, Nanda V. Free vascularized bone graft for nonunion of the scaphoid. J Hand Surg Am 2000; 25 (3) 507-519
- 13 Jones Jr DB, Bürger H, Bishop AT, Shin AY. Treatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. A comparison of two vascularized bone grafts. J Bone Joint Surg Am 2008; 90 (12) 2616-2625
- 14 Fuchs B, Steinmann SP, Bishop AT. Free vascularized corticoperiosteal bone graft for the treatment of persistent nonunion of the clavicle. J Shoulder Elbow Surg 2005; 14 (3) 264-268
- 15 Grant I, Berger AC, Ireland DC. A vascularised bone graft from the medial femoral condyle for recurrent failed arthrodesis of the distal interphalangeal joint. Br J Plast Surg 2005; 58 (7) 1011-1013
- 16 Del Piñal F, García-Bernal FJ, Regalado J, Ayala H, Cagigal L, Studer A. Vascularised corticoperiosteal grafts from the medial femoral condyle for difficult non-unions of the upper limb. J Hand Surg Eur Vol 2007; 32 (2) 135-142
- 17 Kakar S, Duymaz A, Steinmann S, Shin AY, Moran SL. Vascularized medial femoral condyle corticoperiosteal flaps for the treatment of recalcitrant humeral nonunions. Microsurgery 2011; 31 (2) 85-92
- 18 Rodríguez-Vegas JM, Delgado-Serrano PJ. Corticoperiosteal flap in the treatment of nonunions and small bone gaps: technical details and expanding possibilities. J Plast Reconstr Aesthet Surg 2011; 64 (4) 515-527
- 19 Jones Jr DB, Rhee PC, Bishop AT, Shin AY. Free vascularized medial femoral condyle autograft for challenging upper extremity nonunions. Hand Clin 2012; 28 (4) 493-501
- 20 Doi K, Akino T, Shigetomi M, Muramatsu K, Kawai S. Vascularized bone allografts: review of current concepts. Microsurgery 1994; 15 (12) 831-841
- 21 Doi K, Sakai K. Vascularized periosteal bone graft from the supracondylar region of the femur. Microsurgery 1994; 15 (5) 305-315
- 22 Yajima H, Tamai S, Ono H, Kizaki K. Vascularized bone grafts to the upper extremities. Plast Reconstr Surg 1998; 101 (3) 727-735 , discussion 736–737
- 23 Hertel R, Masquelet AC. The reverse flow medial knee osteoperiosteal flap for skeletal reconstruction of the leg. Description and anatomical basis. Surg Radiol Anat 1989; 11 (4) 257-262
- 24 Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987; (214) 160-164
- 25 Babhulkar S, Pande K, Babhulkar S. Nonunion of the diaphysis of long bones. Clin Orthop Relat Res 2005; (431) 50-56
- 26 Ribak S, Medina CE, Mattar Jr R, Ulson HJ, Ulson HJ, Etchebehere M. Treatment of scaphoid nonunion with vascularised and nonvascularised dorsal bone grafting from the distal radius. Int Orthop 2010; 34 (5) 683-688
- 27 Yao J, Read B, Hentz VR. The fragmented proximal pole scaphoid nonunion treated with rib autograft: case series and review of the literature. J Hand Surg Am 2013; 38 (11) 2188-2192
- 28 Geris L, Sloten JV, Van Oosterwyck H. Connecting biology and mechanics in fracture healing: an integrated mathematical modeling framework for the study of nonunions. Biomech Model Mechanobiol 2010; 9 (6) 713-724
- 29 Friedrich JB, Pederson WC, Bishop AT, Galaviz P, Chang J. New workhorse flaps in hand reconstruction. Hand (NY) 2012; 7 (1) 45-54
- 30 Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 1975; 55 (5) 533-544
- 31 De Smet L. Treatment of non-union of forearm bones with a free vascularised corticoperiosteal flap from the medial femoral condyle. Acta Orthop Belg 2009; 75 (5) 611-615
- 32 Cohen MS, Jupiter JB, Fallahi K, Shukla SK. Scaphoid waist nonunion with humpback deformity treated without structural bone graft. J Hand Surg Am 2013; 38 (4) 701-705
- 33 Malizos KN, Dailiana ZH, Innocenti M, Mathoulin CL, Mattar Jr R, Sauerbier M. Vascularized bone grafts for upper limb reconstruction: defects at the distal radius, wrist, and hand. J Hand Surg Am 2010; 35 (10) 1710-1718
- 34 Bakri K, Shin AY, Moran SL. The Vascularized Medial Femoral Corticoperiosteal Flap for Reconstruction of Bony Defects within the Upper and Lower Extremities. Semin Plast Surg 2008; 22 (3) 228-233
- 35 Choudry UH, Bakri K, Moran SL, Karacor Z, Shin AY. The vascularized medial femoral condyle periosteal bone flap for the treatment of recalcitrant bony nonunions. Ann Plast Surg 2008; 60 (2) 174-180