Donorsite defect of medial femoral condyle corticoperiostal flap in the treatment of lower limb infected nonunions

Abstract

Backgrounds Chronic osteomyelitis is a major challenge in orthopaedic surgery; it is the result of open fracture, periprosthetic infection and septic arthritis. Osteomyelitis leads to fracture nonunion. The treatment of bone infection and infected nonunion consists primarily of the complete removal of infected and avascular bone and soft tissue from the surgical site, followed by local and systemic pathogen-specific antibiotic therapy and temporary stabilisation, but may lead to massive skeletal and soft tissue defects. The use of free or pedicled vascularised bone transfers and callus distraction techniques (bone transport) has been recommended for large bone defects. The aim of this study is to evaluate the results of patients affected by infected non-unions of the lower limbs, treated with a corticoperiosteal flap from the medial femoral condyle and to investigate the donor site morbidity of this flap. Materials and methods The patients were 11 males (average age of 45.6 years), who presented a nonunion of the tibial diaphysis in 7 cases and non-union of femoral diaphysis in 4 cases, treated with free or pedicled corticoperiosteal flap. In all patients, surgical debridement was performed before the flap of infected bone and soft tissues that would not contribute to wound healing. Clinical and radiographic evaluations of the recipient site were performed. Preoperative and postoperative X-ray and MRI scans after the 3-year follow-up of the donor site were performed, in order to observe possible bone restoration and any complications. Results The patients reported complete clinical and radiographic bone healing in 90.9 % of cases. As regards donor site, there were no differences between the medial femoral donor condyle compared to the contralateral site, due to complete regeneration of donor site bone. MRI investigation showed complete restoration of the donor site with vascularised bone in all patients. Conclusions Our results suggest that the use of bone flaps for the treatment of infected non-unions is an effective procedure, that must be performed after accurate debridement of the non-union site. The corticoperiosteal flap seems to have few morbidities on the donor site and a high percentage of successful bone healing.

Correlation between Risk Factors and Healing Times in Long Bone Nonunions Treated with Corticoperiosteal Flap from the Medial Femoral Condyle

“…In this study, the corticoperiosteal flap has been demonstrated to be an effective and safe procedure for the treatment of the recalcitrant atrophic nonunion of long bones, demonstrating a rate of bone healing of 94.92% (56/59 patients) with a mean radiographic bone healing time of 4.08 ± 1.29 months (range: 2–6 months) and low morbidity of the donor site, as widely described in the literature. 4 5 6 22 23 24 25…”

“…In this study, the corticoperiosteal flap has been demonstrated to be an effective and safe procedure for the treatment of the recalcitrant atrophic nonunion of long bones, demonstrating a rate of bone healing of 94.92% (56/59 patients) with a mean radiographic bone healing time of 4.08 AE 1.29 months (range: 2-6 months) and low morbidity of the donor site, as widely described in the literature. [4][5][6][22][23][24][25] This study has some limitations: this is a retrospective study, the site of nonunion and the hardware used to do the fixation were not homogeneous, the surgical procedure was executed by two different surgeons in two different institutions, and a relatively small number of patients were enrolled for the study. To reduce the differences caused by the execution of the surgery by two different surgeons and in two different hospitals, the inclusion and exclusion criteria had been well established and shared by the two institutions participating in the study, providing the same approach to the pathology and the same surgical technique.…”

“…2 Numerous procedures, both conservative and surgical, have been proposed to treat recalcitrant nonunions. 3 Among the surgical treatments, the corticoperiosteal flap, harvested from the medial femoral condyle, is increasingly used in nonunions with small bone loss due to its high osteogenic power and periosteal flexibility, high success rate, low donor-site morbidity, [4][5][6][7] and the possibility of being harvested as an osteo-periosteal-cutaneous flap in case of concurrent little soft tissue defect. 8 The causative factors, which can change the local biology of the fracture and reduce the physiologic repair process, leading to nonunion, can be divided into patient-dependent and patient-independent ones.…”

Femur Fracture Following Medial Femoral Condyle Flap Harvest: A Case Report

“…All of these have contributed to the increasing use of the MFC free flap in reconstructing defects of diverse sizes and designs. [7][8][9][10][11][12][13][14][15]…”