Medial Femoral Condyle Flap Research Articles

Free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis

Objective To evaluate the outcomes of the free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis and review the utility of this procedure. Methods Eleven cases of old scaphoid fracture with bone necrosis were treated with the free medical femoral condyle bone grafting between Feburay, 2013 and May, 2015 (9 males and 2 females) . The average age was 34 years ranged from 27 to 55 years. Six cases were in left wrist, and other 5 cases were in right. Six cases were in waist area, and the other 5 cases were proximal pole nonunion. All cases were evaluated with 3D-CT scan, while humpback deformity were occurred in 6 cases, and avascular necrosis at the proximal pole were occurred in 3 cases. After refreshing the fracture, the free medical femoral condyle bone was transferred to the scaphoid, reduct the scaphoid and fix with the Kirschner wire. An end-to-side anastomosis was performed with the bone flap artery and the radial artery, accompanied by the end to end anastomosis of the flap vein and the vein with the radial artery. The plaster was used for 8 weeks. Bone healing was evaluated with X-ray and 3D CT scan. A functional review was performed after the operation and a Mayo wrist scoring test was taken 6 months after the treatment. Results The average followed-up period was 13.1 months(ranged from 9 to 24 months). Bone union were demonstrated in all cases at 13.4 weeks after the operation(ranged from 11 to 18 weeks). Mayo wrist scoring testing showed excellent in 5 cases, good in 4 cases, and fair in 2 cases. Conclusion Free bone flap of medial femoral condyle is constant in vascular anatomy, and is easy to perform with plenty bone graft and less morbidity at donor site. Medial femoral condyle bone flap transplantation based on the descending gennicular vessels is an effective method for treatment of old scaphoid fracture with bone necrosis. Key words: Scaphoid; Old fracture; Descending genicular artery; Medial femoral condyle bone flap

Versatility of the Medial Femoral Condyle Flap for Extremity Reconstruction and Identification of Risk Factors for Nonunion, Delayed Time to Union, and Complications.

The medial femoral condyle (MFC) flap has become a popular choice for treatment of small bony defects. We aim to describe outcomes after MFC flap treatment of upper and lower extremity osseous defects and test the null hypothesis that no factors influence risks for nonunion, increased time to union, and complications. A retrospective chart review was performed on all patients undergoing MFC free vascularized bone flaps by the senior author between May 2010 and March 2016. Preoperative, intraoperative, and postoperative data were collected. We identified 29 patients for inclusion (22 upper and 7 lower extremity reconstructions) treated with the MFC flap for diagnoses including long bone nonunion, avascular necrosis (AVN), or AVN with nonunion. Mean postoperative follow-up was 56 weeks. The average patient was 38 years old (range = 17-61 years) and had undergone 1.5 previous failed surgeries. Union was achieved in 86% of patients at a mean of 15.8 weeks (83% at 17.9 weeks for the scaphoid). No patient with lunate AVN progressed. There were no intraoperative flap complications or bone flap loss, but 28% underwent additional unplanned surgical procedures. We identified previous surgery as a risk factor for delayed union but did not observe significant risk factors predictive of nonunion or complications requiring unplanned reoperation. Extremity reconstruction using the MFC corticocancellous flap results in a high rate of union yet minimal donor morbidity for a challenging patient cohort. Previous surgery was a risk factor for increased time to union.

Free flaps for head and neck cancer in paediatric and neonatal patients.

To review recent literature on the subject of free tissue transfer options in paediatric head and neck surgery, with a particular emphasis on highlighting the advantages and disadvantages of different reconstructions in the paediatric patient. Free tissue transfer in paediatric patients is predictable and applicable for a wide range of congenital and acquired defects in the head and neck. The free fibula flap is a mainstay of mandibular reconstruction and allows excellent implant-supported prosthodontic rehabilitation and growth potential at the recipient site with little or no donor site morbidity. Other less commonly explored options include the deep circumflex iliac artery flap, scapula flap and medial femoral condyle flap. The gracilis mucle remains the mainstay for facial reanimation with other options including pectoralis minor, rectus abdominis, extensor digitorum brevis and latissimus dorsi. There are compelling arguments for centralization of services and creative strategies in postoperative rehabilitation (e.g. play therapy). Free flaps in paediatric patients are a viable option and may even have advantages relative to adults because of the absence of atherosclerosis, purported lower risk of vasospasm and proportionally larger vessel size. Transfer earlier in life maximizes functional potential and 'normalizes' treatment.

MEDIAL FEMORAL CONDYLE CORTICOPERIOSTEAL FLAP: ANATOMIC STUDY.

ABSTRACTObjective The medial femoral condyle corticoperiosteal flap is irrigated by the descending genicular artery, and when this is absent, by the superior medial genicular artery. The descending genicular artery divides into the muscular, saphenous, and osteoarticular branches. The objective of this study was to describe the variables involved in the dissection of the medial femoral condyle flap.Methods Thirty thighs from 20 cadavers were dissected and the following variables were recorded: age, height, weight, thigh length, presence of the descending genicular artery, whether the saphenous branch originated from the descending genicular artery, the length of the branches originating from the descending genicular artery, and the diameter of the descending genicular artery and the vena comitans.Results The descending genicular artery was present in 93.3% of the specimens (28/30). The saphenous branch originated from this artery in 76.7% of the dissections (23/70). The mean distance between the origin of the descending genicular artery and the knee joint was 13.4 cm (±١.4), the mean length of the descending genicular artery was 7.5 cm (±1.5), the mean diameter of the descending genicular artery was 1.9 mm (±٠.3), and the mean diameter of the vena comitans was 1.7 mm (±٠.3).Conclusion The vascularized medial femoral condyle is a versatile option for reconstruction of musculoskeletal injuries. It allows transference of bone associated with muscle and skin, which are each nourished by independent branches. Level of Evidence IV; Case series.

Comparison of two kinds of bone flap transplantation for treatment of old scaphoid fracture

Objective To compare surgical procedure and clinical effects of bone flap transplantation vascularized by recurrent branch of the radial artery and by descending genicular artery in the treatment of old scaphoid fracture. Methods From June 2009 to June 2015, a total of 49 patients with old scaphoid fracture were retrospectively reviewed. 22 cases were treated by internal fixation with transplantation of radial styloid bone flap pedicled on the recurrent branch of the radial artery, while the other 27cases by internal fixation with free grafting of medial femoral condyle bone flap pedicled on the descending genicular artery. The operation time, fracture healing time and wrist function were compared between the two groups. Results The operation time of the descending genicular artery bone flap group (186.00±26.48) min was greater than that of the radial styloid bone flap group (107.00±25.18) min (t=10.617,P<0.001). However, the fracture healing time of the radial styloid bone flap group (16.90±3.58) weeks was longer than that of the descending genicular artery bone flap group (13.20±3.10) weeks (t=3.874,P<0.001). Modified Mayo wrist scoring system was used to evaluate the wrist function 6 months after the surgery. In the radial styloid bone flap group, the results were excellent in 12 cases, good in 9 cases, and fair in 1 case with the average score being 87. In the descending genicular artery bone flap group, the results were excellent in 12 cases, good in 13 cases, fair in 1 case, and poor in 1 case with the average score being 81. There was no significant difference between the two groups. Conclusion Both of the surgical procedures are effective methods for treating old scaphoid fracture. The free grafting of medial femoral condyle bone flap pedicled on the descending genicular artery is faster in fracture healing, but more time-consuming and demanding. Key words: Scaphoid bone; Fractures,ununited; Vascularized bone flap

Surgeon-Based 3D Printing for Microvascular Bone Flaps

Background Three-dimensional (3D) printing has developed as a revolutionary technology with the capacity to design accurate physical models in preoperative planning. We present our experience in surgeon-based design of 3D models, using home 3D software and printing technology for use as an adjunct in vascularized bone transfer. Methods Home 3D printing techniques were used in the design and execution of vascularized bone flap transfers to the upper extremity. Open source imaging software was used to convert preoperative computed tomography scans and create 3D models. These were printed in the surgeon's office as 3D models for the planned reconstruction. Vascularized bone flaps were designed intraoperatively based on the 3D printed models. Results Three-dimensional models were created for intraoperative use in vascularized bone flaps, including (1) medial femoral trochlea (MFT) flap for scaphoid avascular necrosis and nonunion, (2) MFT flap for lunate avascular necrosis and nonunion, (3) medial femoral condyle (MFC) flap for wrist arthrodesis, and (4) free fibula osteocutaneous flap for distal radius septic nonunion. Templates based on the 3D models allowed for the precise and rapid contouring of well-vascularized bone flaps in situ, prior to ligating the donor pedicle. Conclusions Surgeon-based 3D printing is a feasible, innovative technology that allows for the precise and rapid contouring of models that can be created in various configurations for pre- and intraoperative planning. The technology is easy to use, convenient, and highly economical as compared with traditional send-out manufacturing. Surgeon-based 3D printing is a useful adjunct in vascularized bone transfer. Level of Evidence Level IV.

Vascularized Medial Femoral Condyle Bone Graft for Resistant Nonunion of the Distal Radius.

Nonunion involving the metaphyseal region of the distal radius is exceedingly rare, usually involving co-morbidity. Patients that have failed multiple prior conventional surgical interventions represent an even more difficult subset to treat; this investigation examined the utility of a specially designed free vascularized medial femoral condyle flap consisting of a central structural block graft with an extended corticoperiosteal sleeve to wrap around the junctions. Six patients (5 males, 1 female) with a mean age of 52 years had failed to achieve union involving the distal radius metaphysis after a mean of 3.7 prior surgeries occurring over a mean period of 24 months. Comorbidities included smoking, alcoholism, chronic nutritional deficiency, and prior osteomyelitis. The unique descending genicular artery medial femoral condyle flap designed to address these patients consisted of a central structural block graft in continuity with an extended corticoperiosteal sleeve. The structural block filled the bone defect, and the corticoperiosteal sleeve wrapped around the bone junctions and the neighboring bone margins. The mean flap size was 5.3 (+/- 1.3) cm long by 4.5 (+/- 0.9) cm wide. Pre-operative to post-operative DASH scores were compared using the paired student' s t-test, with p < 0.05. All flaps achieved union at a mean of 6.8 (+/- 2.1) weeks following surgery, using the criteria of bridging trabeculae on all 3 radiographs: coronal, sagittal, and oblique. The mean pre-operative DASH score of 63 (+/- 10) was statistically significantly different compared to the mean post-operative DASH score of 18 (+/- 8). With few alternative solutions able to address this unique and difficult problem, the structural block of vascularized bone with the extended corticoperiosteal sleeve proved able to achieve a union that had failed multiple previous attempts and able to resist reactivation of infection, in a challenging group of patients with comorbidities.

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

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.

Free Medial Femoral Condyle Flap for Reconstruction of Scaphoid Pseudarthrosis

Objective/Hypothesis: Nonunions of scaphoid are routinely treated by reconstruction with interposition of cancellous bone grafts from the iliac crest or distal radius. In unfavorable situations as persistent pseudarthrosis following surgical reconstruction or avascular proximal pole, vascularized bone grafts are preferred. Free vascularized bone grafts from the medial femoral condyle were introduced as an additional tool for reconstruction and showed promising results. Material and Methods: In this study, 71 scaphoid nonunions or pseudarthrosis were followed after reconstruction with vascularized bone graft form the medial femur. In 15 cases, an osteocartilaginous graft was used to replace the proximal pole. After a minimum follow-up of 6 months (64 patients), following data were evaluated: consolidation, complications, donor site morbiditiy, pain in rest and stress, range of motion, grip strength, and Krimmer score. Results: Consolidation rate was 88%, in 19.6 % minor complications occurred. Range of motion did not change significantly, 89% grip strength of opposite site could be regained. Pain (VAS) in rest was reduced by 73%, in stress by 51%. Donor site morbiditiy is tolerable: 14.5% had mild symptoms after 3 months, reducing to less than 2% after 6 months. Krimmer Score resulted in very good and good results in 60% of the cases. Conclusion: Reconstruction of scaphoid pseudarthrosis with the free medial femoral condyle bone graft is an adequate technique to reach high consolidation rates in unfavorable situations. Postoperative function improves in terms of grip strength and pain reduction. Range of motion impairment usually persists. The surgical technique is challenging, but the quality of the bone graft is superior to the pediculated bone grafts of the distal radius. In addition, the distal femur offers the possibility of a osteocartilaginous graft to replace the complete proximal pole. Frequently, salvage surgery like 4 corner fusion can be avoided by this technique.

Arterialized Venous Bone Flaps: An Experimental Investigation.

In arterialized venous flaps (AVFs) the venous network is used to revascularize the flap. While the feasibility of AVFs in soft tissues has been reported there is no study on osseous AVFs. In this study we aim to assess the flap survival of osseous AVFs in a pig model. Medial femoral condyle flaps were elevated in 18 pigs. Three groups were created: AVF (n = 6), conventional arterial flap (cAF, n = 6) and bone graft (BG, n = 6). The AVFs were created by anastomosis of genicular artery with one vena comitans while leaving one efferent vein for drainage. After 6 months the specimens were harvested. The histology and histomorphometry of of the bone in cAF and AVF was significantly superior to bone grafts with a higher bone volume in AVFs (p = 0.01). This study demonstrates that osseous free flaps may be supported and survive using the technique of arterialization of the venous network. The concept of AVFs in osseous flaps may be feasible for revascularization of free flaps with an inadequate artery but well developed veins. Further experimental and clinical studies are needed to assess the feasibility of clinical use of arterialized venous bone flaps.

Functional results after total cricoidectomy with medial femoral condyle free flap reconstruction.

Our goal was to describe a laryngeal-preserving single-stage procedure for the treatment of low-grade chondrosarcomas of the larynx: a total cricoidectomy with medial femoral condyle flap reconstruction. The study was designed as a case series of three consecutive patients with low-grade chondrosarcomas of the cricoid cartilage lamina, diameter 4.4, 5.2, 3.8cm, respectively, who underwent total cricoidectomy in 2012. Single-staged reconstruction of the defect with medial femoral condyle flap including the periosteum and thin underlying cortical layer of the bone was conducted. Oncologic and functional results were observed during 3years of follow-up. No evidence of tumor recurrence was detected during follow-up. One month after surgery, all patients were able to tolerate a soft diet and to speak satisfactorily. None of the patients reported aspiration after surgery nor experienced aspiration-related problems, which was confirmed by means of the Leipzig-Pearson scale. The speech ability was good, maximum phonation time was 14, 18, 21s, respectively, and the voice handicap index scores ranged from 24 to 36 and had improved noticeably at 1, 3 and 6months follow-up. Two patients were ultimately decannulated, and one female still has a tracheostomy; however, she is able to keep the tracheostoma closed for most of the time, maintaining good phonatory and swallowing functions. Total cricoidectomy with reconstruction by means of medial femoral condyle flap may replace the total laryngectomy in large low-grade chondrosarcomas of the cricoid cartilage.

Combination of microvascular medial femoral condyle and iliac crest flap for hemi-midface reconstruction

In midface defects including the orbit (Brown class III and IV), no single flap can provide adequate reconstruction. In this technical note, the combination of vascularized iliac crest flap and vascularized medial femoral condyle flap (MFC) is described. The vascularized iliac crest flap is reported to be the gold standard for maxilla reconstruction. There is, however, no consensus on the best method for orbital and nasal wall reconstruction. The MFC flap can be harvested as a thin corticoperiosteal flap or as an osteomyocutaneous flap. Due to the periosteal blood supply, this flap can be customized for an individual defect of the upper hemi-midface. It is therefore of great benefit in orbital and nasal wall reconstruction. By combining the deep circumflex iliac artery (DCIA) bone flap and the MFC flap, the best standard reconstruction technique of the hemi-maxilla can be combined with a new anatomical precise microvascular reconstruction technique of the orbit. A nearly symmetric midface appearance can be achieved.

New options for vascularized bone reconstruction in the upper extremity.

Originally described in the 1970s, vascularized bone grafting has become a critical component in the treatment of bony defects and non-unions. Although well established in the lower extremity, recent years have seen many novel techniques described to treat a variety of challenging upper extremity pathologies. Here the authors review the use of different techniques of vascularized bone grafts for the upper extremity bone pathologies. The vascularized fibula remains the gold standard for the treatment of large bone defects of the humerus and forearm, while also playing a role in carpal reconstruction; however, two other important options for larger defects include the vascularized scapula graft and the Capanna technique. Smaller upper extremity bone defects and non-unions can be treated with the medial femoral condyle (MFC) free flap or a vascularized rib transfer. In carpal non-unions, both pedicled distal radius flaps and free MFC flaps are viable options. Finally, in skeletally immature patients, vascularized fibular head epiphyseal transfer can provide growth potential in addition to skeletal reconstruction.

Histological evaluation of a free medial femoral condyle flap at 21 months

Recalcitrant nonunions typically require vascularized bone for reconstruction. In this report, we present a case of an index finger middle phalanx nonunion that was successfully treated with a free medial femoral condyle corticocancellous flap. Nearly 2 years after the free tissue transfer, the patient underwent debulking of the bone flap. This gave us the unique opportunity to examine the histology of the vascularized bone.

Applications of the Medial Femoral Condyle Free Flap for Foot and Ankle Reconstruction

Avascular necrosis (AVN) or persistent nonunion occurs in situations of poor vascular supply. Some specific situations that plague the foot and ankle surgeon are talus nonunion, talus AVN, navicular AVN, and failed ankle arthrodesis with bone loss. The medial femoral condyle (MFC) flap has emerged as a popular source of vascularized corticocancelous bone. We present a series of cases demonstrating the versatility of the MFC flap in complex foot and ankle pathology. A retrospective review was completed of all MFC flaps used in the foot and ankle over the past 5 years. Five patients were identified (average age 48). Surgical indications included talar AVN and ankle arthritis, talar nonunion, and navicular AVN. All patients had undergone conventional bone grafting techniques, which failed, prior to being treated with a MFC free flap; this series of patients did not possess significant medical comorbidities. Fixation techniques included compression screw fixation, plate osteosynthesis, or fine wire external fixation. The average follow-up was 20 months (range 8 to 40 months). There was a 100% flap success rate with no returns to the operating room for thrombosis. The volume of the bone flaps was 5.6 cm(3) (range 1 cm(3) to 12 cm(3)). The average follow-up time was 20 months (range 8 to 40 months). All cases resulted in union, and full weight bearing status was achieved at a mean of 23.8 weeks (range 10 to 52 weeks) postoperatively. Vascularized bone transfer in the form of the MFC free flap was a valuable method for foot and ankle reconstruction. The MFC flap provided an alternative for those defects that were smaller then 3 cm in length. In our experience, for small bone defects requiring vascularized bone, the MFC flap is currently the ideal donor location supplanting the iliac crest. Level IV, retrospective case series.

Medial Femoral Condyle Flap Donor-Site Morbidity

The medial femoral condyle has become a reliable source of vascularized bone with many advantages to the reconstructive microsurgeon. The authors examined the donor-site morbidity of medial femoral condyle flap harvest. A retrospective review of all patients who underwent medial femoral condyle free flap procedures between April of 2009 and December of 2010 was conducted. Study participants underwent computed tomographic scans of their bilateral distal femurs and knee joints to evaluate the donor site and examine differences between the operated and nonoperated sides. Fifteen patients underwent medial femoral condyle free flap procedures. Ten of them agreed to participate in the study. The average time between surgery and computed tomographic scans was 18.0 months (range, 12.2 to 30.4 months). Average bone harvested per procedure was 16.1 cm3 (range, 2 to 34 cm3), representing an average condylar volume of 9 percent (range, 1 to 18 percent). Reparative bone formation was minimal, with an average thickness of 4.5 mm (range, 4 to 6 mm). There were no findings of new degenerative joint disease on computed tomographic scans resulting from medial femoral condyle harvest. The flap success rate was 100 percent (10 of 10) for patency and achieving osseous union. There were no major or flap-related complications. Two patients reported numbness of the donor site at long-term follow-up (average, 17.5 months; range, 12.2 to 30.4 months). Medial femoral condyle harvest creates minimal donor-site morbidity according to radiographic measures at more than 1-year follow-up. Surgeons can anticipate minimal unassisted bone regeneration at the donor site at this time interval.

Cutaneous Angiosome Territory of the Medial Femoral Condyle Osteocutaneous Flap

The medial femoral condyle flap is used for treatment of nonunions with or without intercalary bone loss. Most reported uses have been without a skin segment, but this flap can provide a skin component supplied by the saphenous artery branch (SAB) of the descending genicular artery (DGA) pedicle. Experience with this flap suggests that an additional distinct, reliable, more-distal, DGA-cutaneous branch can be found at condyle level, capable of supporting skin without using the SAB. This cadaver study evaluated SAB and DGA-cutaneous branch angiosome territories. A clinical case series assesses the DGA-cutaneous branch's clinical utility. The DGA and SAB were isolated in 12 cadaveric legs, divided, and separately cannulated. Red dye and methylene blue were selectively injected into each vessel manually. Skin perfusion was measured and photographed. In all specimens, the DGA was present, originating 14.2 cm proximal to the joint line, and demonstrated a distinct cutaneous branch at condyle level. This vessel provided an average perfusion area of 70 cm(2), centered over the medial knee. The SAB was identified in 11 specimens (92%), with an average perfusion area of 361 cm(2) along the medial aspect of the distal thigh and proximal leg. The DGA communicating branch was present and used for perfusion of the skin paddle in 17 of 20 cases. The SAB was present in 18 of 20 cases, used with DGA-communicating branch in 4 cases, and the sole source of skin perfusion in 1 case. In 2 remaining cases, neither the SAB nor DGA communicating branch was adequate for perfusion of a skin segment. The medial femoral condyle flap can be harvested with a large skin paddle based on the SAB. A smaller skin segment can be harvested using the more distal DGA-communicating branch at condyle level. Improved understanding of the skin island associated with the DGA's saphenous and cutaneous branches can provide a rapid, reliable method of skin-segment harvest.

Comparison of the Osseous Characteristics of Medial Femoral Condyle and Fibula Flaps

Comparison of the Osseous Characteristics of Medial Femoral Condyle and Fibula Flaps

Thumb salvage with skin grafted medial femoral corticoperiosteal free flap

A 23-year-old man suffered a severe crush injury with fracture of his left thumb base phalanx and destruction of his extensor pollicis longus tendon. Immediate plate stabilisation and soft tissue coverage was performed; however, a recalcitrant pseudarthrosis developed in this compliant non-smoker despite three revisions with avascular iliac crest grafts for interphalangeal joint arthrodesis, corticocancellous bone application and hardware exchange. An attempt to improve thumb vascularity and soft tissue cover with a pedicled Foucher flap as well as through extracorporeal shock wave therapy failed. Bone healing and subsequent thumb salvage were finally achieved with a free vascularised medial femoral condyle (MFC) bone flap, which was covered directly with a full-thickness skin graft. Both bony and soft tissue healing went well and after 3 months the patient returned to work. This case demonstrates that skin grafting the periosteal surface of the MFC flap is safe and results in a thin skin-bone compositae transplant which also might be very useful for indications other than hand surgery.