Article
Use of medial femoral condyle flap for treatment of non-union and avascular necrosis of the upper limb. Cadaveric study and morbidity analysis of 18 cases
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Authors
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Gonzalo Mallarino
- Fundación Cardioinfantil, Bogotá, Colombia
-
Camilo Romero
- Fundación Cardioinfantil, Bogotá, Colombia
| Published: | February 6, 2020 |
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Outline
Text
Objectives/Interrogation:
- 1.
- To describe the vascular anatomy of the medial femoral condyle flap in a cadaveric study.
- 2.
- To demonstrate a relevant classification for the clinical practice.
- 3.
- Review our experience for the treatment of non-union, and avascular necrosis in the upper limb through a case series, making an emphasis on donor-site morbidity and Patient Reported Outcomes (PRO's)
Methods: First phase: twenty legs of 10 cadavers were studied with an intravascular injection of latex; the pedicle length, ramification pattern, and femur length was described.
Second phase: A retrospective study of 18 patients with avascular necrosis or non-unions of the upper limb, that were reconstructed with medial femoral condyle flap, was conducted. Time from injury to reconstruction, consolidation, and pain improvement was recorded. Higgins questionnaire was used in the 6th month follow-up in order to describe patient overall satisfaction, and complaints regarding both the donor and the receptor area in order to assess the outcomes with PRO's; X-rays of the knee used for flap dissection were utilized to further describe donor-related morbidity.
Results and Conclusions: In phase one, the pedicle raised from the genicular descending artery in 20 (100%) of the cases. Vascular anatomy variability was best described with "Y" and "H" patterns. "Y" pattern was more frequent being found on 13 (65%) the specimens. 94% of cases from phase two were secondary cases, that had received previous surgery. The average time from injury to reconstruction was 24 months, and to bone union was 2,5 months. All patients referred improvement in pain, and were satisfied with the results, no alterations were found on the X-rays.
Conclusion: The medial femoral condyle is a flap with a rather consistent anatomy, which is better described with the "Y" and "H" classification. All patients reported improvement of pain, with minimal subjective and objective donor-site morbidity, making of the medial femoral condyle flap a very useful option for non-unions, and avascular necrosis of the upper extremity, even when multiple surgeries have been previously attempted and failed.
