Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology
Background: Complex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial femoral condyle (MFC) flaps provide vascularized periosteum, skin, and corticocancellous bone. Methods: A retrospective, single-institution cohort st...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2019-11-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011419884269 |
| _version_ | 1818242604158943232 |
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| author | John T. Stranix MD Merisa L. Piper MD Said C. Azoury MD Geoffrey Kozak MD Oded Ben-Amotz MD Keith L. Wapner MD L. Scott Levin MD |
| author_facet | John T. Stranix MD Merisa L. Piper MD Said C. Azoury MD Geoffrey Kozak MD Oded Ben-Amotz MD Keith L. Wapner MD L. Scott Levin MD |
| author_sort | John T. Stranix MD |
| collection | DOAJ |
| description | Background: Complex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial femoral condyle (MFC) flaps provide vascularized periosteum, skin, and corticocancellous bone. Methods: A retrospective, single-institution cohort study of consecutive MFC flaps performed for complicated hindfoot reconstruction between 2013 and 2019 was reviewed. Radiologic follow-up assessed osseous union and clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Thirty MFC flaps were performed in 28 patients for complex hindfoot pathology. Twenty-seven flaps had adequate clinical and radiographic follow-up (mean 15.8 months). Results: The majority presented with avascular necrosis (83%) and failed prior operations (67%, mean 3.1). Most hindfoot procedures involved arthrodesis (n = 24, 80%); tibiotalocalcaneal (n = 11) and talonavicular (n = 7) most frequently. Mean osseous flap volume was 10.3 cm 3 (range 1.7-18.4 cm 3 ); one flap required takeback for venous congestion but no total flap losses occurred. Primary osseous union was initially achieved in 20 patients (74%, mean 217 days). Six flaps developed interface nonunion; 5 underwent revision arthrodesis and ultimately achieved union in 24/27 flaps (89%, mean 271 days). Risk factors for nonunion were body mass index (BMI) >30 ( P = .017) and prior arthrodesis ( P = .042). Mean AOFAS hindfoot scores increased significantly from 52.3 preoperatively to 70.7 postoperatively ( P < .001). Subscore analysis demonstrated significant improvement in postoperative pain scores from 14.2 to 27.3 out of 40 ( P < .001). Conclusion: The MFC free flap provided vascularized bone for complicated foot and ankle reconstruction with relatively low donor site morbidity, promising osseous union results, and improved functional outcomes. Level of Evidence: Level IV, retrospective case series. |
| first_indexed | 2024-12-12T13:47:52Z |
| format | Article |
| id | doaj.art-befab6936e7f473ea33bf52f681472c8 |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-12-12T13:47:52Z |
| publishDate | 2019-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-befab6936e7f473ea33bf52f681472c82022-12-22T00:22:38ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142019-11-01410.1177/2473011419884269Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle PathologyJohn T. Stranix MD0Merisa L. Piper MD1Said C. Azoury MD2Geoffrey Kozak MD3Oded Ben-Amotz MD4Keith L. Wapner MD5L. Scott Levin MD6 Department of Plastic Surgery, University of Virginia Health System, Charlottesville, VA, USA Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA Department of Orthopedic Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA Department of Orthopedic Surgery, University of Pennsylvania Health System, Philadelphia, PA, USABackground: Complex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial femoral condyle (MFC) flaps provide vascularized periosteum, skin, and corticocancellous bone. Methods: A retrospective, single-institution cohort study of consecutive MFC flaps performed for complicated hindfoot reconstruction between 2013 and 2019 was reviewed. Radiologic follow-up assessed osseous union and clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Thirty MFC flaps were performed in 28 patients for complex hindfoot pathology. Twenty-seven flaps had adequate clinical and radiographic follow-up (mean 15.8 months). Results: The majority presented with avascular necrosis (83%) and failed prior operations (67%, mean 3.1). Most hindfoot procedures involved arthrodesis (n = 24, 80%); tibiotalocalcaneal (n = 11) and talonavicular (n = 7) most frequently. Mean osseous flap volume was 10.3 cm 3 (range 1.7-18.4 cm 3 ); one flap required takeback for venous congestion but no total flap losses occurred. Primary osseous union was initially achieved in 20 patients (74%, mean 217 days). Six flaps developed interface nonunion; 5 underwent revision arthrodesis and ultimately achieved union in 24/27 flaps (89%, mean 271 days). Risk factors for nonunion were body mass index (BMI) >30 ( P = .017) and prior arthrodesis ( P = .042). Mean AOFAS hindfoot scores increased significantly from 52.3 preoperatively to 70.7 postoperatively ( P < .001). Subscore analysis demonstrated significant improvement in postoperative pain scores from 14.2 to 27.3 out of 40 ( P < .001). Conclusion: The MFC free flap provided vascularized bone for complicated foot and ankle reconstruction with relatively low donor site morbidity, promising osseous union results, and improved functional outcomes. Level of Evidence: Level IV, retrospective case series.https://doi.org/10.1177/2473011419884269 |
| spellingShingle | John T. Stranix MD Merisa L. Piper MD Said C. Azoury MD Geoffrey Kozak MD Oded Ben-Amotz MD Keith L. Wapner MD L. Scott Levin MD Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology Foot & Ankle Orthopaedics |
| title | Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology |
| title_full | Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology |
| title_fullStr | Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology |
| title_full_unstemmed | Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology |
| title_short | Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology |
| title_sort | medial femoral condyle free flap reconstruction of complex foot and ankle pathology |
| url | https://doi.org/10.1177/2473011419884269 |
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