Free vascularized medial femoral condyle corticoperiosteal flap with non-vascularized iliac crest graft for the treatment of recalcitrant clavicle non-union

Jaloux, Charlotte; Bettex, Quentin; Levadoux, Michel; Cerlier, Alexandre; Iniesta, A.; Legré, R.; Mayoly, Alice

doi:10.1016/j.bjps.2020.03.018

Cited by 12 publications

(14 citation statements)

References 39 publications

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“…After applying inclusion and exclusion criteria, the search strategy yielded 10 papers, 1 2 18 19 20 21 22 23 24 25 encompassing a total of 26 patients who underwent a unilateral vascularized MFC flap for clavicle reconstruction. Mean number of patients per study was 2.6, with a median of 1.5 and interquartile range of 3.…”

Section: Resultsmentioning

confidence: 99%

Vascularized Reconstruction of Recalcitrant Clavicular Nonunion with the Medial Femoral Condyle Free Flap: A Systematic Review of the Literature

Karunaratne

Romeo

2024

Journal of Hand and Microsurgery

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Recalcitrant clavicular nonunion is an uncommon but challenging problem. Vascularized bone reconstruction is not first-line therapy due to complexity and donor morbidity, though it has utility in select cases. A systematic review of Embase and Medline databases was undertaken for cases of medial femoral condyle reconstruction for clavicle nonunion. Ten studies met inclusion, encompassing 26 patients. Mean age was 38.9 years. Ten patients were male and 16 female. Mean time of nonunion was 37.79 months prior to intervention; mean time to union following medial femoral condyle flap was 7.60 months. Two patients did not achieve union. Of the 11 patients who previously had at least one failed fixation with bone graft, considered the current “gold standard”, 9 patients (81.81%) went on to achieve union, while 2 patients (18.19%) did not. There were six reported complications in five patients. Medial femoral condyle flap is a valuable option in recalcitrant clavicle nonunion.

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Section: Resultsmentioning

confidence: 99%

Vascularized Reconstruction of Recalcitrant Clavicular Nonunion with the Medial Femoral Condyle Free Flap: A Systematic Review of the Literature

Karunaratne

Romeo

2024

Journal of Hand and Microsurgery

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“…Several case series reporting the outcome of surgical treatment with vascularized autografts have been published. [26][27][28][29][30][31][32][33][34][35] In the largest reported case series of seven patients, with segmental defects between 2 and 5 cm, consolidation was achieved in all patients using a vascularized medial femoral condyle autograft. 29 Smaller series describing the clinical outcome of vascularized medial femoral condyle grafts and vascularized fibular grafts in segmental defects between 2 and 12 cm reported consolidation in 60-75% of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…29 Smaller series describing the clinical outcome of vascularized medial femoral condyle grafts and vascularized fibular grafts in segmental defects between 2 and 12 cm reported consolidation in 60-75% of the patients. 27,31 However, a recent systematic review by Allsopp et al found that compelling evidence for the use of vascularized bone grafts in large segmental defects is lacking. 37 Vascularized grafts lead to prolonged operative time, an extended in-hospital stay and infection and bleeding are common complications.…”

Section: Discussionmentioning

confidence: 99%

Large segmental defects in midshaft clavicle nonunion treated with autologous tricortical iliac crest bone graft

2021

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Background To evaluate the use of intercalary iliac crest bone graft in the treatment of clavicle nonunion with a large segmental bone defect (3–6 cm). Methods This retrospective study evaluated patients with large segmental bone defects (3–6 cm) after clavicle nonunion, treated with open reposition internal fixation and iliac crest bone graft between February 2003 and March 2021. At follow-up the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was administered. A literature search was performed to provide an overview of commonly used graft types per defect size. Results We included five patients treated with open reposition internal fixation and iliac crest bone graft for clavicle nonunion with a median defect size of 3.3 cm (range 3–6 cm). Union was achieved in all five, and all pre-operative symptoms resolved. The median DASH score was 23 out of 100 (IQR 8-24). An extensive literature search revealed that there are no studies describing the use of an used iliac crest graft for defects larger than 3 cm. Instead, a vascularized graft was typically used to treat defects sizes between 2.5 and 8 cm. Discussion An autologous non-vascularized iliac crest bone graft can be safely used and is reproducible to treat a midshaft clavicle non-union with a bone defect between 3 and 6 cm.

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“…The midclavicle is also very close to the brachial plexus and axillary artery; therefore, care must be taken to relieve or prevent compression of the neurovascular bundle. Multiple studies have described the use of vascularized fibula 108 109 110 111 112 and MFC 113 114 VBGs for clavicular reconstruction, the majority of which resulted in good functional outcomes. The MFC flap can harvested as a periosteal or corticoperiosteal flap, potentially with iliac NVBG, to provide better conformability to the clavicle along with periosteal vascularization.…”

Section: Specific Upper Extremity Defect Sitesmentioning

confidence: 99%

Vascularized Bone Graft Reconstruction for Upper Extremity Defects: A Review

et al. 2023

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Upper extremity reconstruction may pose clinical challenges for surgeons due to the often-critical, complex functional demands of the damaged and/or missing structures. The advent of vascularized bone grafts (VBGs) has aided in reconstruction of upper extremity (UE) defects due to their superior regenerative properties compared with nonvascularized bone grafts, ability to reconstruct large bony defects, and multiple donor site options. VBGs may be pedicled or free transfers and have the potential for composite tissue transfers when bone and soft tissue are needed. This article provides a comprehensive up-to-date review of VBGs, the commonly reported donor sites, and their indications for the treatment of specific UE defects.

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Free vascularized medial femoral condyle corticoperiosteal flap with non-vascularized iliac crest graft for the treatment of recalcitrant clavicle non-union

Cited by 12 publications

References 39 publications

Vascularized Reconstruction of Recalcitrant Clavicular Nonunion with the Medial Femoral Condyle Free Flap: A Systematic Review of the Literature

Vascularized Reconstruction of Recalcitrant Clavicular Nonunion with the Medial Femoral Condyle Free Flap: A Systematic Review of the Literature

Large segmental defects in midshaft clavicle nonunion treated with autologous tricortical iliac crest bone graft

Vascularized Bone Graft Reconstruction for Upper Extremity Defects: A Review

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