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

Mattos, David Issa; Ko, Jason H.; Iorio, Matthew L.

doi:10.1002/micr.30368

Cited by 14 publications

(11 citation statements)

References 25 publications

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“…It is well-known that the osteogenic potential of a vascularized graft allows more reliable and rapid fusion than cancellous bone graft or allograft. 17 Moreover, according to Mattos et al, 12 besides the structural and osteogenic advantages that VBG offer, one chief advantage is the delivery of systemic antibiotics to the infected radiocarpal area and hastened bone integration. There are risks of performing vascularized allograft, due to donor-host immunity, and necessity of continued immunosuppressive drugs, even with the availability of more advanced drugs; therefore, currently there is no indication for such grafts.…”

Section: Discussionmentioning

confidence: 99%

“…This will represent a serious clinical challenge, but one that must be taken seriously, since delay in treatment will be devastating for the anatomic structures and could increase the risk of amputation. [12][13][14] As the infection progresses, an intense inflammatory response will evolve, leading to the production of microthrombi, depleting circulation, decreasing oxygen perfusion, and ultimately causing necrosis and lysis of the bone, with structure collapse. 14 At this stage, the infection is notoriously difficult to treat.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Solution for Total Carpectomy due to Destructive Wrist Pan-Osteomyelitis Using a Free Femoral Condyle Osteocutaneous Flap for Wrist Arthrodesis

Castillo-Vázquez

Palafox-Carral

Romo-Rodríguez

et al. 2022

Journal of Hand and Microsurgery

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Osteomyelitis of the hand is rare, even more so in the carpal bones. Patients with rheumatoid arthritis (RA) have a higher infection rate overall, and up to a 14-fold increase in the incidence of septic arthritis of the hand. The destruction of immunologic barriers, such as cartilage and joint capsules, as well as the use of immunosuppressive medications will have an impact on the higher incidence of articular infections and osteomyelitis in these patients. Infection in these cases is often overlooked because of the similarity of presentation to an acute event of RA. When osteomyelitis is present, rapid and aggressive treatment should be given. Surgical debridement, lavage, and excision of necrotic bone is the best choice, followed by cemented antibiotic impregnated spacer to resolve the acute scenario. Vascularized bone grafts (VBG) can then be used for a definitive solution, as these have great biologic properties that increase the possibility of a good outcome. We hereby present a report of a wrist arthrodesis, using a free medial femoral condyle VBG for the treatment of destructive osteomyelitis of the carpal bones in a female patient with RA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical Solution for Total Carpectomy due to Destructive Wrist Pan-Osteomyelitis Using a Free Femoral Condyle Osteocutaneous Flap for Wrist Arthrodesis

Castillo-Vázquez

Palafox-Carral

Romo-Rodríguez

et al. 2022

Journal of Hand and Microsurgery

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“…2,4 It has been employed to perform wrist arthrodesis, repair scaphoid fracture non-unions, and distal radial metaphyseal nonunions. 3,5 The MFC flap has been used to reconstruct the nose after rhinectomy, to repair partial or total maxillectomy defects, and repair the premaxilla in a patient with median facial dysplasia. [6][7][8] Gaggl et al have successfully used an osteoperiosteal femur flap to treat defects of the anterior maxillary alveolar ridge after tooth loss in 5 patients with clefts of lip, palate, and alveolus.…”

Section: Discussionmentioning

confidence: 99%

“…2 This flap has most commonly been used for bony defects or non-unions of the extremities after trauma or tumor resection, including thumb fractures, wrist osteomyelitis, and distal radius and femur non-union. [2][3][4][5] The MFC flap has also been used to reconstruct craniofacial osseous defects in the nasal bones, maxilla, and mandible. [6][7][8] An alveolar cleft (AC) defect must be repaired to support eruption of the cleft-side lateral incisor and canine, closure of oronasal fistulae, and creation of a continuous maxillary arch.…”

Section: Introductionmentioning

confidence: 99%

Medial Femoral Condyle Flap for Persistent Alveolar Cleft Reconstruction

Abraha

Day

Padilla

et al. 2020

FACE

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An alveolar cleft (AC) is typically repaired using a non-vascularized bone graft from the iliac crest. Such alveolar bone grafts (ABGs) are reliable but not infallible. We present the case of an 18-year-old male with a persistent AC with the instability of the cleft-side medial incisor and canine, status post 4 failed ABGs. The medial femoral condyle (MFC) flap was chosen to provide vascularized and similarly contoured bone. The patient recovered well and now has adequate bone stock for dental restoration.

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“…4 Also free osseous flaps such as a medial femoral condylar flap and a vascularized fibula can be used for successful healing. 10 Recent studies have demonstrated that performing a TWF results in a high degree of patient satisfaction with mean Disabilities of the Arm, Shoulder and Hand (DASH) scores of 25 to 38. [11][12][13][14][15] However, Wei and Feldon reported an overall complication rate of 29% among 1,782 wrist arthrodeses, and a reoperation rate of 19%.…”

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confidence: 99%

Complications and Factors Associated with Reoperation following Total Wrist Fusion

et al. 2020

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Background Total wrist fusion can be elected to relieve pain in patients with osteoarthritis and rheumatoid arthritis. This study aimed to investigate the overall complications and the factors associated with reoperation and soft tissue complication after total wrist fusion. Methods We retrospectively identified adult patients who underwent total wrist fusion using Current Procedural Terminology (CPT) codes, International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) and verified these by medical chart review. We included patients (n = 215) who were treated at a single institutional system from January 1, 2002 to January 1, 2019. The mean age was 53.3 ± 15.0 years and the median follow-up was 6.1 years (interquartile range [IQR] =1.7–9.0). The most common indications for wrist fusion included inflammatory arthritis (n = 66, 31%), degenerative arthritis (n = 59, 27%), and posttraumatic arthritis (n = 47, 22%). All wrist fusions were performed using a dorsal fusion plate or dorsal spanning plate, either with a local autograft (n = 167, 78%), iliac crest autograft (n = 2, 1.0%), allograft (n = 7, 3.3%), a combination of both (n = 16, 7.4%), or without a graft (n = 23, 11%). We performed a multivariable logistic regression to evaluate factors associated with reoperation. In addition, we performed a similar analysis to identify the factors associated with soft tissue complication after total wrist fusion. Results Forty-one (19%) patients underwent reoperation at a median of 6.9 months (IQR = 3.9–18). The indications included symptomatic implants (n = 12, 27%), implant failures (n = 8, 20%), infections (n = 7, 17%), and nonunions (n = 6, 15%). In multivariable analysis, total wrist fusion of the dominant hand (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.1–4.7, p = 0.033) was associated with a higher reoperation rate. Soft tissue complications occurred in 20 patients (9.3%) consisting of hematomas (n = 8, 3.7%), observed blistering (n = 5, 2.3%), and observed wound dehiscence (n = 4, 1.9%). In multivariable analysis, smoking (OR: 2.5, CI: 0.95–6.4, p = 0.010) was independently associated with soft tissue complication after total wrist fusion. Seventy-two (33%) patients had a postoperative complication including symptomatic hardware (n = 16, 7.4%), implant failure (n = 11, 5.1%), infection (n = 11, 5.1%), nonunion (n = 8, 3.7%), and carpal tunnel syndrome (n = 4, 1.9%). Conclusion Roughly one-third (33%) of the patients undergoing total wrist fusion experience a postoperative complication and 19% of the patients underwent a reoperation. Total wrist fusion of the dominant hand results in higher reoperation rates. The risk of a soft tissue complication after total wrist fusion is increased in smokers.

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

Abstract: These cases illustrate the use of the MFC in wrist arthrodesis after osteomyelitis defects. In all cases, there was complete union in a short time, no recurrence of infection, and low donor-site morbidity.

Cited by 14 publications

References 25 publications

Surgical Solution for Total Carpectomy due to Destructive Wrist Pan-Osteomyelitis Using a Free Femoral Condyle Osteocutaneous Flap for Wrist Arthrodesis

Surgical Solution for Total Carpectomy due to Destructive Wrist Pan-Osteomyelitis Using a Free Femoral Condyle Osteocutaneous Flap for Wrist Arthrodesis

Medial Femoral Condyle Flap for Persistent Alveolar Cleft Reconstruction

Complications and Factors Associated with Reoperation following Total Wrist Fusion

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