gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Vascularised bone graft from distal femur in upper extremity reconstruction

Meeting Abstract

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  • presenting/speaker Igor Golubev - Priorov State Medical Research Centre, Moscow, Russia
  • Maksim Merkulov - Priorov State Medical Research Centre, Moscow, Russia
  • Oleg Bushuev - Priorov State Medical Research Centre, Moscow, Russia
  • Ilya Kutepov - Priorov State Medical Research Centre, Moscow, Russia
  • Ivan Kukin - Priorov State Medical Research Centre, Moscow, Russia
  • Maksim Sautin - ECSTO, Moscow, Russia

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1866

doi: 10.3205/19ifssh1049, urn:nbn:de:0183-19ifssh10492

Published: February 6, 2020

© 2020 Golubev et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: To analyse our experience and indications for vascularised bone graft from distal femur and its application in upper extremity reconstruction.

Methods: Since 2012 to 2018 authors have performed 53 surgical procedures using free vascularised femur condyle bone grafts. 51 of them were medial femoral condyle grafts (MFC) and 2 - lateral femoral condyle grafts (LFC). MFC were used for scaphoid bone grafting (19), Kienböck's disease (7), bone defects after tumor excision (2), osteochondritis dissecans of the humerus condyle (1). It was also used in cases of forearm bones (14), humerus (5), metacarpal bones (2) and clavicle (1) nonunions.

LFC were made for the scaphoid nonunion and in case of a gunshot injury of 3-5 metacarpal bones. Osteochondral graft was performed in 11 cases. In one case we used osteocutaneous flap.

Results and Conclusions: We have used a. descendens genicularis and her transverse branch for the MFC. Average length of the pedicle was 5,7 cm (from 1,5 to 8 cm). LFC was taken with the superior lateral artery (average length 3,75 cm). Average volume of the bone graft was 7,44 cm3 (1 to 28,1 cm3). For the osteochondral graft it was 3,38 cm3 (2 to 6,9 cm3). Bone healing was achieved in 36 of 39 (92.3%) cases which were investigated in one year after surgery.

We have analysed donor site morbidity after MFC harvest. Complaints of 13 patients' were analysed. They included pain, numbness and instability. 3 patients with MFC (23%) reported issues: pain in 3 (23%) and numbness in 1 (8%).

Swelling occurred in 2 (15%) of patients. There was no statistically significant correlation between the postoperative time and patients' complaints (p>0,05). We conducted a survey using the Lower Extremity Functional Scale (LEFS). In MFC group LEFS minimum score was 71 points, maximum - 80, average - 77,6.

According to our practice main indication for MFC and LFC flaps are proximal scaphoid nonunion with failure of previous operation or destruction of proximal pole, Kienbock's disease stage IIIA, long bone defects less than 5 cm with at least one failure of surgical treatment and Koenig disease of capitulum humeri with bone necrosis of more than 50% of it.

High rate of success and low donor site mobility make distal femur the main donor area for relatively small bone defects and convex cartilage bone defects.