Lambeau libre composite ostéo-chondro-cutané de trochlée fémorale médiale dans les lésions cartilagineuses du scaphoïde et du lunatum : avantages d’une palette cutanée

Abstract

A medial femoral trochlea (MFT) flap is a chondrocorticoperiosteal flap. It is a new technique described for the reconstruction of cartilage lesions. There are few descriptions of the surgical technique for harvesting this flap in its chondro-cortical form with a skin paddle. We describe and report the early results of three cases of the composite medial femoral trochlea flap, with a skin paddle. Between May 2017 and August 2017 three males were treated by a free osteochondrocutaneous graft withdraw from the medial femoral trochlea. Two cases of proximal scaphoid nonunion and one case of Kienböck disease were treated in our department. The buried osteochondroperiosteal graft was monitored on immediate postoperative oversight thanks the skin paddle, every 2 h for 5 days according to our free flap protocol. In two cases, the cutaneous pallet allowed rescue of the osteochondral flap. After 10 weeks mean postoperative, a CT scan showed complete bone healing and pins were removed. After one year follow-up, the three patients no longer had wrist pain, wrist mobility were good and patients had no discomfort in their knee. MFT flap vascularization come from the descending genicular artery (DGA) who divides into three branches: the cutaneous branch from the DGA (DGA-CB), the longitudinal periosteal branch, and the transversal periosteal branch. In about 90% of cases, a skin island flap, overlying the medial area of the knee, could be associated with the MFT flap, most often based on the DGA-CB. Associating a skin paddle is often easy and has numerous benefits such as flap monitoring, preventing vessel compression, and replacing damaged skin without high donor site morbidity. The MFT flap with a cutaneous skin paddle appears to be a safe and promising way of preventing carpal arthritis in the treatment of wrist bones nonunion or necrosis in the presence of cartilage destruction.