Medial Femoral Condyle Vascularized Bone Graft for Treatment of Midshaft Clavicle Recalcitrant Nonunion With Use of the Transverse Cervical Artery as an Anastomosis

Belyea, Christopher M; Lansford, Jefferson L.; Golden, Joseph B; Shin, Emily H.; Gumboc, Rey

doi:10.5435/jaaosglobal-d-19-00049

Cited by 5 publications

(7 citation statements)

References 19 publications

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“…After applying inclusion and exclusion criteria, the search strategy yielded 10 papers, 1 2 18 19 20 21 22 23 24 25 encompassing a total of 26 patients who underwent a unilateral vascularized MFC flap for clavicle reconstruction. Mean number of patients per study was 2.6, with a median of 1.5 and interquartile range of 3.…”

Section: Resultsmentioning

confidence: 99%

“…The thoracoacromial vessels were the most commonly utilized in our review, though it has been noted that due to local scarring, they can be difficult to access, in which case the transverse cervical vessels may be of more utility. 21 Both have been well described in the plastic and reconstructive surgery literature and establishing access to these should be within the armamentarium of the reconstructive surgeon. [53][54][55] In certain situations, the concept of the reconstructive elevator (i.e., early utilization of the more complex and more appropriate operation) may be more suitable than the reconstructive ladder approach.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Vascularized Reconstruction of Recalcitrant Clavicular Nonunion with the Medial Femoral Condyle Free Flap: A Systematic Review of the Literature

Karunaratne

Romeo

2024

Journal of Hand and Microsurgery

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Recalcitrant clavicular nonunion is an uncommon but challenging problem. Vascularized bone reconstruction is not first-line therapy due to complexity and donor morbidity, though it has utility in select cases. A systematic review of Embase and Medline databases was undertaken for cases of medial femoral condyle reconstruction for clavicle nonunion. Ten studies met inclusion, encompassing 26 patients. Mean age was 38.9 years. Ten patients were male and 16 female. Mean time of nonunion was 37.79 months prior to intervention; mean time to union following medial femoral condyle flap was 7.60 months. Two patients did not achieve union. Of the 11 patients who previously had at least one failed fixation with bone graft, considered the current “gold standard”, 9 patients (81.81%) went on to achieve union, while 2 patients (18.19%) did not. There were six reported complications in five patients. Medial femoral condyle flap is a valuable option in recalcitrant clavicle nonunion.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Vascularized Reconstruction of Recalcitrant Clavicular Nonunion with the Medial Femoral Condyle Free Flap: A Systematic Review of the Literature

Karunaratne

Romeo

2024

Journal of Hand and Microsurgery

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“…The medial femur condyle (MFC) flap has been popularized as an alternative for microsurgical reconstruction of small and medium bone defects (Del Pinal et al, 2007; Sakai et al, 1991). Originally described as a periosteal flap, it has been used in the cortico‐periosteal form for the reconstruction of long bones and successfully also for the clavicula (Belyea et al, 2020; Fuchs et al, 2005) and the scaphoid (Deng et al, 2020; Keating et al, 2021; Keller et al, 2020; Pet & Higgins, 2019). Its main advantages are the versatility and the possibility to customize the flap to irregular bones and the possibility to include cartilage as an osteochondral flap.…”

Section: Discussionmentioning

confidence: 99%

Complex reconstruction of the clavicle with a prefabricated medial femur condyle chimeric flap including a superficial circumflex iliac artery perforator flap: A case report

Giesen,

Costa,

Fritsche

2023

Microsurgery

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The medial femur condyle (MFC) cortico‐periosteal flap is a popular flap for bone reconstruction. The use of a chimeric version of this flap with a skin island has been described, but anatomical arterial variation can occur that prevent its harvest. Furthermore, the donor area of the skin paddle has been debated as poor because of the scarring in a visible area and because of the difficulty in obtaining pliable thin skin. We present a fabricated chimeric MFC cortico‐periosteal flap joined with a superficial inferior epigastric perforator (SCIP) flap to reconstruct and augment a sclerotic and insufficient small clavicula with the skin paddle acting as a monitor and as a substitute for the overlying skin. A 52‐year‐old female patient had a history of multiple refractures of the right hypoplastic clavicle with a diameter of 7 mm, resulting in a sclerotic bone with a fibrotic scar. The reconstruction was done in one surgical session using a cortico‐periosteal flap from the left medial condyle and a thin SCIP flap from the left groin. The area of the clavicle to be reconstructed was 3 cm, and the direct overlying skin (approximately 6 × 3 cm) was severely scarred and painful. The MFC flap was 5 × 4 cm, while the SCIP flap was 7 × 3.5 cm. The SCIP flap artery was anastomosed on the table end‐to‐side to the descending genicular (DG) artery of the MFC, and the vein was anastomosed end‐to‐end to a comitans vein of the DG artery. The flap fully survived after an initial congestion. At 12 months, we observed a satisfactory reconstruction of the clavicle with an enhanced diameter of 12 mm. The patient recovered full function of the shoulder with no pain. Using a fabricated chimeric flap composed of a medial femoral condyle and a superficial circumflex artery perforator flap may be an additional option for tailored reconstruction of complex osteo‐cutaneous defect of clavicle.

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“…Several case series reporting the outcome of surgical treatment with vascularized autografts have been published. 26 – 35 In the largest reported case series of seven patients, with segmental defects between 2 and 5 cm, consolidation was achieved in all patients using a vascularized medial femoral condyle autograft. 29 Smaller series describing the clinical outcome of vascularized medial femoral condyle grafts and vascularized fibular grafts in segmental defects between 2 and 12 cm reported consolidation in 60–75% of the patients.…”

Section: Discussionmentioning

confidence: 99%

Large segmental defects in midshaft clavicle nonunion treated with autologous tricortical iliac crest bone graft

2021

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Background To evaluate the use of intercalary iliac crest bone graft in the treatment of clavicle nonunion with a large segmental bone defect (3–6 cm). Methods This retrospective study evaluated patients with large segmental bone defects (3–6 cm) after clavicle nonunion, treated with open reposition internal fixation and iliac crest bone graft between February 2003 and March 2021. At follow-up the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was administered. A literature search was performed to provide an overview of commonly used graft types per defect size. Results We included five patients treated with open reposition internal fixation and iliac crest bone graft for clavicle nonunion with a median defect size of 3.3 cm (range 3–6 cm). Union was achieved in all five, and all pre-operative symptoms resolved. The median DASH score was 23 out of 100 (IQR 8-24). An extensive literature search revealed that there are no studies describing the use of an used iliac crest graft for defects larger than 3 cm. Instead, a vascularized graft was typically used to treat defects sizes between 2.5 and 8 cm. Discussion An autologous non-vascularized iliac crest bone graft can be safely used and is reproducible to treat a midshaft clavicle non-union with a bone defect between 3 and 6 cm.

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Medial Femoral Condyle Vascularized Bone Graft for Treatment of Midshaft Clavicle Recalcitrant Nonunion With Use of the Transverse Cervical Artery as an Anastomosis

Cited by 5 publications

References 19 publications

Vascularized Reconstruction of Recalcitrant Clavicular Nonunion with the Medial Femoral Condyle Free Flap: A Systematic Review of the Literature

Vascularized Reconstruction of Recalcitrant Clavicular Nonunion with the Medial Femoral Condyle Free Flap: A Systematic Review of the Literature

Complex reconstruction of the clavicle with a prefabricated medial femur condyle chimeric flap including a superficial circumflex iliac artery perforator flap: A case report

Large segmental defects in midshaft clavicle nonunion treated with autologous tricortical iliac crest bone graft

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