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

Abstract

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.

Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology

“…A recent study showed that previous surgery is a risk factor for nonunion following MFC reconstruction of both the upper and lower extremity. 18 History of prior failed arthrodesis as a risk factor for nonunion after MFC reconstruction likely reflects a higher degree of compromised blood supply to the residual hindfoot bones as a result of the significant prior surgical intervention(s).…”

Wrist arthrodesis with the medial femoral condyle flap: Outcomes of vascularized bone grafting for osteomyelitis

“…In a recent review of 29 patients at a single institution, there were no cases of permanent donor site injury such as knee instability, femoral fracture, pain, or numbness. (Kazmers et al, )…”

“…(Masden, Iorio, & Higgins, ) The average vascular pedicle length is 7.7 cm. (Kazmers et al, ) When resection is limited to the MFC, knee stability is not affected long‐term and there is very minimal risk of an iatrogenic femur fracture. Additionally, while it is difficult to identify the nutrient vessels for smaller bone segments of other VBGs, the vascular territory of bone perfused by the DGA has been studied, and therefore taking small segments from it are more predictable.…”

“…In a recent review of 29 patients at a single institution, there were no cases of permanent donor site injury such as knee instability, femoral fracture, pain, or numbness. (Kazmers et al, 2018) The MFC can be molded to the appropriate size and shape necessary for partial or total wrist arthrodesis, even when the entire carpus has been removed. While the largest corticocancellous segment taken in our series was 24 cm 3 , the DGA has been shown to perfuse the femur on average 13.7 cm proximal to the joint line, with resection limited distally by the medial collateral ligament.…”

“…(Choudry, Bakri, Moran, Karacor, & Shin, 2008) A potential solution for a readily available VBG with minimal donor site morbidity is the medial femoral condyle (MFC). (Kazmers, Thibaudeau, Gerety, Lambi, & Levin, 2018) This VBG has a robust blood supply from the descending geniculate artery (DGA), and can be harvested in combination with muscle, cartilage or skin. (Iorio, Masden, & Higgins, 2011) When used in hand reconstruction, the MFC has most commonly been used to treat scaphoid and metacarpal non-unions, where it has demonstrated a higher rate of union than distal radius pedicled vascular grafts.…”