Medial Femoral Condyle Free Flap: A Systematic Review and Proportional Meta-analysis of Applications and Surgical Outcomes

Overview

Journal Plast Reconstr Surg Glob Open

Specialty General Surgery

Date 2024 Apr 10

PMID 38596574

Authors

Matteo Scampa

Vladimir Megevand

Jerome Martineau

Dirk J Schaefer

Daniel F Kalbermatten

Carlo M Oranges

Affiliations

Soon will be listed here.

Abstract

Background: Recalcitrant bone nonunion and osseous defect treatment is challenging and often requires vascularized bone transfer. The medial femoral condyle flap has become an increasingly popular option for reconstruction. The study aims at reviewing its different applications and synthesizing its surgical outcomes.

Method: A systematic review including all studies assessing surgical outcomes of free medial femoral condyle flap for bone reconstruction in adults was conducted on January 31, 2023. Flap failure and postoperative complications were synthesized with a proportional meta-analysis.

Results: Forty articles describing bony reconstruction in the head and neck, upper limb, and lower limb areas were selected. Indications ranged from bony nonunion and bone defects to avascular bone necrosis. Multiple flaps were raised as either pure periosteal, cortico-periosteal, cortico-cancellous-periosteal, or cortico-chondro-periosteal. A minority of composite flaps were reported. Overall failure rate was 1% [95% confidence interval (CI), 0.00-0.08] in head & neck applications, 4% in the lower limb (95% CI, 0.00-0.16), 2% in the upper limb (95% CI, 0.00-0.06), and 1% in articles analyzing various locations simultaneously (95% CI, 0.00-0.04). Overall donor site complication rate was 4% (95% CI, 0.01-0.06). Major reported complications were: femoral fractures (n = 3), superficial femoral artery injury (n = 1), medial collateral ligament injury (n = 1), and septic shock due to pace-maker colonization (n = 1).

Conclusion: The medial femoral condyle flap is a versatile option for bone reconstruction with high success rates and low donor site morbidity.

Citing Articles

Thumb Metacarpal Reconstruction with a Medial Femoral Condyle Flap.

Kang N, Brady C, Talwar C, Ajam Y, Nikkhah D Plast Reconstr Surg Glob Open. 2024; 12(7):e5974.

PMID: 39015358 PMC: 11251677. DOI: 10.1097/GOX.0000000000005974.

References

Elgammal A, Lukas B . Vascularized medial femoral condyle graft for management of scaphoid non-union. J Hand Surg Eur Vol. 2014; 40(8):848-54. DOI: 10.1177/1753193414561900. View

Muramatsu K, Doi K, Ihara K, Shigetomi M, Kawai S . Recalcitrant posttraumatic nonunion of the humerus: 23 patients reconstructed with vascularized bone graft. Acta Orthop Scand. 2003; 74(1):95-7. DOI: 10.1080/00016470310013734 . View

Guzzini M, Ciclamini D, Arioli L, Titolo P, Carrozzo A, Latini F . Correlation between Risk Factors and Healing Times in Long Bone Nonunions Treated with Corticoperiosteal Flap from the Medial Femoral Condyle. J Reconstr Microsurg. 2022; 39(7):502-507. DOI: 10.1055/a-2004-2364. View

Jones Jr D, Moran S, Bishop A, Shin A . Free-vascularized medial femoral condyle bone transfer in the treatment of scaphoid nonunions. Plast Reconstr Surg. 2010; 125(4):1176-1184. DOI: 10.1097/PRS.0b013e3181d1808c. View

del Pinal F, Garcia-Bernal F, Regalado J, Ayala H, Cagigal L, Studer A . Vascularised corticoperiosteal grafts from the medial femoral condyle for difficult non-unions of the upper limb. J Hand Surg Eur Vol. 2007; 32(2):135-42. DOI: 10.1016/J.JHSB.2006.10.015. View

Moura L, Carvalho P, Xavier C, Post L, Torriani M, Santagata M . Autogenous non-vascularized bone graft in segmental mandibular reconstruction: a systematic review. Int J Oral Maxillofac Surg. 2016; 45(11):1388-1394. DOI: 10.1016/j.ijom.2016.05.004. View

Burger H, Windhofer C, Gaggl A, Higgins J . Vascularized medial femoral trochlea osteocartilaginous flap reconstruction of proximal pole scaphoid nonunions. J Hand Surg Am. 2013; 38(4):690-700. DOI: 10.1016/j.jhsa.2013.01.036. View

Politikou O, Wirth S, Giesen T, Guggenberger R, Giovanoli P, Calcagni M . Corticoperiosteal medial femoral condyle flap for recalcitrant nonunion in ankle and foot: Outcomes and radiological evaluation of donor site morbidity. Foot Ankle Surg. 2020; 26(8):918-923. DOI: 10.1016/j.fas.2019.12.008. View

Mehio G, Morsy M, Cayci C, Sabbagh M, Shin A, Bishop A . Donor-Site Morbidity and Functional Status following Medial Femoral Condyle Flap Harvest. Plast Reconstr Surg. 2018; 142(5):734e-741e. DOI: 10.1097/PRS.0000000000004886. View

10.

Vegas M, Delgado P, Roger I, Carosini R . Vascularized periosteal transfer from the medial femoral condyle: is it compulsory to include the cortical bone?. J Trauma Acute Care Surg. 2012; 72(4):1040-5. DOI: 10.1097/TA.0b013e31823dc230. View

11.

Huang T, Sabbagh M, Lu C, Steinmann S, Moran S . The vascularized medial femoral condyle free flap for reconstruction of segmental recalcitrant nonunion of the clavicle. J Shoulder Elbow Surg. 2019; 28(12):2364-2370. DOI: 10.1016/j.jse.2019.04.044. View

12.

di Summa P, Sapino G, Zaugg P, Raffoul W, Guillier D . The periosteal-cutaneous chimeric medial femoral condyle free flap for subtotal ear reconstruction: A case report. Microsurgery. 2020; 40(7):814-817. DOI: 10.1002/micr.30657. View

13.

Banaszewski J, Gaggl A, Andruszko A . Medial femoral condyle free flap for head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2019; 27(2):130-135. DOI: 10.1097/MOO.0000000000000517. View

14.

Ling X, Peng X . What is the price to pay for a free fibula flap? A systematic review of donor-site morbidity following free fibula flap surgery. Plast Reconstr Surg. 2011; 129(3):657-674. DOI: 10.1097/PRS.0b013e3182402d9a. View

15.

Dimitriou R, Jones E, McGonagle D, Giannoudis P . Bone regeneration: current concepts and future directions. BMC Med. 2011; 9:66. PMC: 3123714. DOI: 10.1186/1741-7015-9-66. View

16.

Pet M, Assi P, Giladi A, Higgins J . Preliminary Clinical, Radiographic, and Patient-Reported Outcomes of the Medial Femoral Trochlea Osteochondral Free Flap for Lunate Reconstruction in Advanced Kienböck Disease. J Hand Surg Am. 2020; 45(8):774.e1-774.e8. DOI: 10.1016/j.jhsa.2019.12.008. View

17.

Doi K, Sakai K . Vascularized periosteal bone graft from the supracondylar region of the femur. Microsurgery. 1994; 15(5):305-15. DOI: 10.1002/micr.1920150505. View

18.

Prevost A, Poulet V, Delanoe F, Lauwers F . Merits of the free periosteal femoral condyle flap in the management of advanced mandibular osteoradionecrosis. Int J Oral Maxillofac Surg. 2022; 52(2):175-180. DOI: 10.1016/j.ijom.2022.05.006. View

19.

Arcuri F, Innocenti M, Menichini G, Pantani C, Raffaini M . Microvascular reconstruction of the mandible with medial femoral condylar flap for treatment of mandibular non-union. Int J Oral Maxillofac Surg. 2021; 51(2):175-181. DOI: 10.1016/j.ijom.2021.05.007. View

20.

Guzzini M, Lanzetti R, Perugia D, Lupariello D, Vadala A, Guidi M . The treatment of long bones nonunions of upper limb with microsurgical cortico-periosteal free flap. Injury. 2017; 48 Suppl 3:S66-S70. DOI: 10.1016/S0020-1383(17)30661-7. View