Femoral Osteonecrosis after Medial Femoral Condyle Bone Graft Harvest

Boretto, Jorge G.; Altube, Gonzalo; Gallucci, Gerardo; Narvaez, Hector R; Carli, Pablo De

doi:10.1097/gox.0000000000001792

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…Moreover, during our review we did not find more information in connection with MFC graft depth. As an isolated report, Boretto et al 27 informed about the risk of femoral osteonecrosis after the harvest of a MFC flap, suggesting the surgeon to mention this potential complication during patient preoperative counseling. Furthermore, it appears that the current indications allow for an up to 5-cm harvest of MFC without concerns of femoral fracture, 28 even though in a previous work, the same author 26 suggested a larger area of bone available for harvest.…”

Section: Discussionmentioning

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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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%

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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“…Furthermore, femoral osteonecrosis after medial condyle bone graft harvest has been reported. 22 The main limitation of the 1,2 ICSRA flap is the treatment of associated scaphoid collapse with humpback deformity. As the scaphoid collapses volarly, a pure dorsal approach to the scaphoid will not allow visualization of the palmar defect and may prevent anatomical correction of the defect, potentially leading to lower union rates.…”

Section: Discussionmentioning

confidence: 99%

Carpal Collapse After Scaphoid Nonunion: A Novel Combined Approach to the 1,2 Intercompartmental Supraretinacular Artery Radial Flap

Vakalopoulos

Balagué

Vostrel

et al. 2020

Journal of Hand Surgery Global Online

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Purpose: Scaphoid nonunion remains a major problem in hand surgery. The 1,2 intercompartmental supraretinacular artery flap (1,2 ICSRA), as first described by Zaidemberg et al, is widely used with reported union rates of approximately 80%. However, its use is limited in the case of associated carpal collapse as in dorsal intercalated segmental instability (DISI) and humpback deformity. In this study, we present a novel approach to this flap enabling the correction of associated carpal collapse. Methods: Between 2006 and 2015, 9 patients with scaphoid nonunion or delayed union with carpal collapse were treated with a vascularized bone flap based on the 1,2 ICSRA using a combined volar and dorsal approach. Immobilization in a short-arm cast was applied for 8 weeks. Union rates, correction of DISI and humpback deformity, as well as clinical end points were noted. In addition, scapholunate (SL) angles were measured using 2 accepted radiological techniques, employing either the scaphoid midline axis or its proximal radiological landmarks as a reference. Results: All cases united and a median time to bone consolidation of 4 months (range, 2e5 months) was observed. Preoperative DISI deformities (n ¼ 4) were corrected in all patients. Humpback deformities (n ¼ 5) were also corrected. Two patients had repeat surgery: one for K-wire removal after bony consolidation and the other for neuropathic pain. Conclusions: The 1,2 ICSRA bone flap is a reliable treatment for scaphoid nonunion associated with carpal collapse. This combined volar and dorsal approach permits the correction of DISI and humpback deformity without compromising the scaphoid vascular supply, which eliminates the need to use free bone flaps from other sites. In this series, we observed a 100% union rate. Two patients required reoperation for symptomatic hardware and dorsal wrist pain linked to superficial neuritis. Type of study/level of evidence: Therapeutic IV.

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“…Biomechanical studies have demonstrated that a large MFC flap can be harvested without risking the femur fracture at the donor site in axial load application. 11,12,19 An MFC flap may include entire medial surface of the condylar and supracondylar region; however, there are some variations in the literature regarding the supposed dimensional limitations of the MFC flap: 10-13 cm (length), 7-8 cm (width) and 1.5 cm (depth). 2,18 Moreover, the flap is anteriorly limited by the medial patellar facet, posteriorly by the posterior border of femur, and distally by the origin of the medial collateral ligament.…”

Section: Dovepressmentioning

confidence: 99%

“…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]…”

Section: Introductionmentioning

confidence: 99%

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

Klarendić¹,

Dovšak²

2021

OAS

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Medial femoral condyle (MFC) corticoperiosteal free flap is a versatile flap that has been gaining popularity in maxillofacial surgery. Its relatively consistent anatomy, ease of harvest and low morbidity of the donor site make it a viable option when a small, wellvascularised piece of corticocancellous bone is needed. So far there have been only three reports of femoral fracture following an MFC free flap harvest. We present the case of a 90year-old female patient with squamous cell carcinoma of the maxilla alveolar ridge, where a 4 × 2 cm MFC free flap was used for reconstruction of the defect after ablative surgery. On the third postoperative day, while the patient was lying in bed -prior to any attempt of patient verticalization -a femur fracture occurred at the donor site, requiring a surgical fixation of the femur. This is a highly uncommon complication; however, it should be taken into consideration when operating on elderly female patients. It is thus of utmost importance to stay well below the femur shaft when harvesting an MFC free flap in such patients.

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Femoral Osteonecrosis after Medial Femoral Condyle Bone Graft Harvest

Cited by 5 publications

References 11 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

Carpal Collapse After Scaphoid Nonunion: A Novel Combined Approach to the 1,2 Intercompartmental Supraretinacular Artery Radial Flap

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

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