Treatment of Recalcitrant Distal Tibial Nonunion Using the Descending Genicular Corticoperiosteal Free Flap

Abstract

Treatment of recalcitrant distal tibial nonunions without bone defect with removal of previous hardware, stable internal fixation, and free corticoperiosteal flap transfer is safe and effective in noninfected cases.

Descending genicular artery free flaps: Multi-purpose tissue transfers in limb reconstruction

“…More recently, Burger 15 reported the use of a medial femoral trochlea osteocartilaginous flap ( Figure 4C), using the transverse osteoarticular branches, for replacement of the proximal pole of the scaphoid. Cavadas 14 reported a composite flap of bone and muscle for coverage of a bone defect and monitoring, using the vastus medialis or the sartorius muscle ( Figure 4B). Huang 18 reported the use of a DGA composite flap, using skin and adductor magnus tendon ( Figure 4C) for Achilles tendon reconstruction.…”

The Synergistic Effect of Autograft and BMP-7 in the Treatment of Atrophic Nonunions

“…The two centers treat on average 8000 musculoskeletal injuries annually; during the time of the study, we saw 157 patients with nonunions. We excluded 55 patients with hypertrophic or septic nonunions, eight patients with contraindication to administration of BMP-7 (rheumatoid arthritis or other systemic inflammatory disease process), 10 were tibial and four femoral nonunions. All nonunions were atrophic, and seven had bone defects of a median length of 2.5 cm (range, 2-4 cm).…”

“…Atrophic nonunions have proven most difficult to treat, often requiring multiple operations and long periods of recovery (in certain series more than three operations on average in periods extending over 10 years) [10,37,53]. Several authors have reported healing rates in over 80% of the cases, mostly with enhancement of the biologic substrate at the fracture site [11,17,29].…”

Contribuição ao estudo anatômico do retalho vascularizado corticoperiosteal do côndilo medial do fêmur

“…Há relatos de bons resultados também no tratamento de pseudoartroses de úmero distal (10) e tíbia distal (11) . Choudry et al (12) enfatizam que o retalho corticoperiosteal do côndilo femoral medial é a melhor indicação no tratamento de pseudoartroses recorrentes menores que 5,0cm.…”