Osteo-periosteal-cutaneous Flaps of the Medial Femoral Condyle: A Valuable Modification for Selected Clinical Situations

ABSTRACT

In situations of bony nonunions with poor skin coverage, transplantation of vascularized soft tissue in addition to bone graft is desirable. The use of the corticoperiosteal vascularized bone graft from the medial femoral condyle is well described. There are only anecdotal reports about its use as an osteocutaneous flap. This article presents our results with the use of an osteocutaneous flap from the medial femoral condyle. Between 2004 and 2009, four patients were treated with supracondylar osteocutaneous flaps for bony nonunions (tibia, ankle, calcaneous) with concomitant soft tissue defects. The size of the osseous grafts ranged from 3 × 5 to 6 × 5 cm. The supplying cutaneous vessels were an unnamed perforator of the descending genicular artery (two cases) or the saphenous branch (two cases). The first three cases healed primarily. Bony union was achieved between 32 and 170 days. The follow-up of the fourth case was too short to achieve a bony union. There was no flap loss or surgery-related complications at the donor site. The transfer of free combined vascularized corticoperiosteal-cutaneous flaps seems to be ideally suited for postradiation-induced fractures or chronic nonunions with poor chances of spontaneous healing and a concomitant small skin defect.

Medial femoral condyle - osteocutaneous flap - nonunion

REFERENCES

• 1 Duhamel H. Sur une racine qui la faculté de teindre en rouge les os de animaux vivants.  Mem Acac Roy Sci. 1739;  521-528
• 2 Stock W, Hierner R, Wolf K. [Vascularized periosteal transplant. A review of a new therapeutic possibility].  Handchir Mikrochir Plast Chir. 1991;  23 149-156
• 3 King K F. Periosteal pedicle grafting in dogs.  J Bone Joint Surg Br. 1976;  58B 117-121
• 4 Takato T, Harii K, Nakatsuka T, Ueda K, Ootake T. Vascularized periosteal grafts: an experimental study using two different forms of tibial periosteum in rabbits.  Plast Reconstr Surg. 1986;  78 489-497
• 5 Penteado C V, Masquelet A C, Romana M C, Chevrel J P. Periosteal flaps: anatomical bases of sites of elevation.  Surg Radiol Anat. 1990;  12 3-7
• 6 Yajima H, Tamai S, Ono H, Kizaki K. Vascularized bone grafts to the upper extremities.  Plast Reconstr Surg. 1998;  101 727-735 discussion 736-737
• 7 Milanov N O, Trofimov E I, Umerenkov A G. [Treatment of long tubular bone pseudoarthrosis with revascularized cortical layer of radius].  Vestn Ross Akad Med Nauk. 1997;  9 38-42
• 8 Stock W, Hierner R, Dielert E, Stotz R, Manninger J, Wolf K. The iliac crest region: donor site for vascularized bone periosteal and soft tissue flaps.  Ann Plast Surg. 1991;  26 105-109
• 9 Hertel R, Masquelet A C. The reverse flow medial knee osteoperiosteal flap for skeletal reconstruction of the leg. Description and anatomical basis.  Surg Radiol Anat. 1989;  11 257-262
• 10 Romana M C, Masquelet A C. Vascularized periosteum associated with cancellous bone graft: an experimental study.  Plast Reconstr Surg. 1990;  85 587-592
• 11 Doi K, Sakai K. Vascularized periosteal bone graft from the supracondylar region of the femur.  Microsurgery. 1994;  15 305-315
• 12 Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft.  Plast Reconstr Surg. 1991;  87 290-298
• 13 Acland R D, Schusterman M, Godina M, Eder E, Taylor G I, Carlisle I. The saphenous neurovascular free flap.  Plast Reconstr Surg. 1981;  67 763-774
• 14 Choudry U H, Bakri K, Moran S L, Karacor Z, Shin A Y. The vascularized medial femoral condyle periosteal bone flap for the treatment of recalcitrant bony nonunions.  Ann Plast Surg. 2008;  60 174-180
• 15 Martin D, Bitonti-Grillo C, De Biscop J et al.. Mandibular reconstruction using a free vascularised osteocutaneous flap from the internal condyle of the femur.  Br J Plast Surg. 1991;  44 397-402
• 16 Doi K, Hattori Y. The use of free vascularized corticoperiosteal grafts from the femur in the treatment of scaphoid non-union.  Orthop Clin North Am. 2007;  38 87-94, vi–vii
• 17 Kobayashi S, Kakibuchi M, Masuda T, Ohmori K. Use of vascularized corticoperiosteal flap from the femur for reconstruction of the orbit.  Ann Plast Surg. 1994;  33 351-357 discussion 357-358
• 18 Larson A N, Bishop A T, Shin A Y. Free medial femoral condyle bone grafting for scaphoid nonunions with humpback deformity and proximal pole avascular necrosis.  Tech Hand Up Extrem Surg. 2007;  11 246-258
• 19 Finley J M, Acland R D, Wood M B. Revascularized periosteal grafts—a new method to produce functional new bone without bone grafting.  Plast Reconstr Surg. 1978;  61 1-6
• 20 Burstein F D, Canalis R F. Studies on the osteogenic potential of vascularized periosteum: behavior of periosteal flaps transferred onto soft tissues.  Otolaryngol Head Neck Surg. 1985;  93 731-735
• 21 van den Wildenberg F A, Goris R J, Tutein Nolthenius-Puylaert M B. Free revascularised periosteum transplantation: an experimental study.  Br J Plast Surg. 1984;  37 226-235
• 22 Puckett C L, Hurvitz J S, Metzler M H, Silver D. Bone formation by revascularized periosteal and bone grafts, compared with traditional bone grafts.  Plast Reconstr Surg. 1979;  64 361-365
• 23 Rintala A E, Ranta R. Periosteal flaps and grafts in primary cleft repair: a follow-up study.  Plast Reconstr Surg. 1989;  83 17-24
• 24 Camilli J A, Penteado C V. Bone formation by vascularized periosteal and osteoperiosteal grafts. An experimental study in rats.  Arch Orthop Trauma Surg. 1994;  114 18-24