Vascularised Corticoperiosteal Grafts from the Medial Femoral Condyle for Difficult Non-Unions of the Upper Limb

Abstract

The vascularised corticoperiosteal graft was introduced by Sakai and Doi, in 1991, as a means to achieve bony union under unfavourable conditions. We present our experience with this vascularised graft, taken from the femoral condyle, in six patients with difficult non-unions (5) or other bony problems (1) in the upper limb. In five cases, a long bone defect--two humeral, two ulnar and one radial--was involved. All had had between three and seven previous operations. Two of the non-unions were secondary to infection. The others had had conventional grafting on two or three previous occasions each. In the sixth case, a corticoperiosteal graft was used to promote healing in a combined carpometacarpal and intercarpal dislocation with a very poor bed. All of the grafts survived without complications and all of the bones healed radiologically in less than three months. Three patients achieved a normal range of motion and two obtained a functional range of motion with only slight limitations. The carpometacarpal arthrodesis was healed soundly at five weeks.

Vascularized bone graft from the supracondylar region of the femur

“…The thin corticoperiosteal graft is then transferred to the recipient site and is wrapped around it. 7 The periphery of the graft is fixed to the recipient bone with silk or wire sutures (see Fig. 1).…”

Chronic Thrombosis in the Descending Genicular Artery during Harvest of a Medial Femoral Condyle Corticocancellous Flap: A Case Report

“…Vascularized MFC corticoperiosteal and corticocancellous flaps have been used to treat nonunions in both small and long bones, respectively [1,[3][4][5]10]. We report a case of chronic thrombosis of the DGA as a potential complication of this flap.…”

“…While the flap was initially proposed for small bone nonunions [5], its favorable characteristics and osteogenic potential have led to its application in long bone nonunions [4]. The advantages of this flap include minimal donor side morbidity, a long noncritical vascular pedicle, and relatively reliable anatomy [7].…”

Sigmoid Notch Reconstruction and Limited Carpal Arthrodesis for a Severely Comminuted Distal Radius Malunion: Case Report

“…We harvested a vascularized corticoperiosteal flap 8 from the medial femoral condyle. 9 A thin layer of cancellous bone was included in the periphery of the flap, progressing up to 1 cm thick at its center. We harvested the flap to include a larger piece of vascularized bone, to later match the larger central defect in the arthrodesis area.…”