Guzzini Matteo, Calderaro Cosma, Guidi Marco, Civitenga Carolina, Ferri Germano, Ferretti Andrea
Department of Orthopaedic and Traumatology, Sant' Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy.
Case Rep Orthop. 2016;2016:5125861. doi: 10.1155/2016/5125861. Epub 2016 Mar 15.
Introduction. The vascularized corticoperiosteal flap is harvested from the medial femoral condyle and it is nourished by the articular branch of the descending genicular artery and the superomedial genicular artery. This flap is usually harvested as a free flap for the reconstruction of bone defects at forearm, distal radius, carpus, hand, and recently at lower limb too. Case Report. A 50-year-old Caucasian man referred to our department for hypertrophic nonunion of the distal femur, refractory to the conservative treatments. The first surgical choice was the revision of the nail and the bone reconstruction with a corticoperiosteal pedicled flap from the medial femoral condyle. We considered union to have occurred 3.5 months after surgery when radiographs showed bridging of at least three of the four bony cortices and clinically the patient was able to walk with full weight bearing without any pain. At the last follow-up (25 months), the patient was completely satisfied with the procedure. Discussion. The corticoperiosteal flap allows a faster healing of fractures with a minimal morbidity at the donor site. We suggest that the corticoperiosteal pedicled flap graft is a reliable and effective treatment for distal femur nonunion.
引言。带血管蒂的皮质骨膜瓣取自股骨内侧髁，由膝降动脉的关节支和膝上内侧动脉供血。该皮瓣通常作为游离皮瓣用于修复前臂、桡骨远端、腕骨、手部的骨缺损，近来也用于下肢骨缺损修复。病例报告。一名50岁的白种男性因股骨远端肥大性骨不连前来我院就诊，保守治疗无效。首选的手术方案是对髓内钉进行翻修，并采用带蒂皮质骨膜瓣对股骨内侧髁进行骨重建。当术后3.5个月的X线片显示四个骨皮质中至少有三个出现骨桥形成，且患者临床能够完全负重行走且无疼痛时，我们认为骨折已愈合。在最后一次随访（25个月）时，患者对手术效果完全满意。讨论。皮质骨膜瓣可使骨折愈合更快，供区并发症最少。我们认为带蒂皮质骨膜瓣移植是治疗股骨远端骨不连的一种可靠且有效的方法。
