Kazmers Nikolas H, Thibaudeau Stephanie, Steinberger Zvi, Scott Levin L
Department of Orthopaedics, University of Utah, Salt Lake City, Utah.
Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, H3A 14A, Canada.
Microsurgery. 2018 Mar;38(3):328-343. doi: 10.1002/micr.30138. Epub 2016 Dec 27.
Free flaps derived from the medial genicular artery (MGA) system, including the medial femoral condyle (MFC) and medial femoral trochlear (MFT) flaps, are potential reconstructive options to address upper and lower extremity bony pathology. Our primary aim was to comprehensively search the literature to describe the spectrum of pathology treated with these flaps, and to assess patient outcomes to improve our understanding of expected union and complication rates.
Following PRISMA guidelines, a systematic review using Pubmed and Embase databases with citation cross-referencing was performed to identify all original clinical articles characterizing MGA flap treatment of upper and lower extremity pathology.
The initial search identified 173 articles which was narrowed down to 40 meeting inclusion criteria, representing a total of 248 cases: 174 and 74 in the upper and lower extremities, respectively. Sixteen distinct recipient sites were identified with union rates ranging from 66 to 100% (98.7% overall). The majority (83.9%) of patients had undergone prior failed surgery. Major complications (those with limb/flap loss or requiring unplanned reoperation) were more frequent for lower versus upper extremity applications (17.1% vs. 6.2%, respectively). Donor site femoral fracture or persistent knee dysfunction occurred in 0.8% and 0.4% of patients, respectively.
MGA free flaps are a versatile option for upper and lower extremity osseous reconstruction, offering high rates of union with minimal complications for a complex patient population. This study furthers our understanding of patient outcomes following MGA flap reconstruction, which previously was limited to case reports and small case series.
源自膝内侧动脉（MGA）系统的游离皮瓣，包括股骨内侧髁（MFC）皮瓣和股骨内侧滑车（MFT）皮瓣，是治疗上下肢骨病变的潜在重建选择。我们的主要目的是全面检索文献，描述用这些皮瓣治疗的病变范围，并评估患者预后，以增进我们对预期愈合率和并发症发生率的理解。
遵循PRISMA指南，使用PubMed和Embase数据库进行系统综述，并进行引文交叉参考，以识别所有描述MGA皮瓣治疗上下肢病变的原始临床文章。
初步检索确定了173篇文章，经筛选后有40篇符合纳入标准，共248例病例：上肢174例，下肢74例。确定了16个不同的受区部位，愈合率在66%至100%之间（总体为98.7%）。大多数（83.9%）患者此前手术失败。下肢应用的主要并发症（肢体/皮瓣丢失或需要计划外再次手术的并发症）比上肢应用更常见（分别为17.1%和6.2%）。供区股骨骨折或持续性膝关节功能障碍分别发生在0.8%和0.4%的患者中。
MGA游离皮瓣是上下肢骨重建的一种通用选择，对于复杂的患者群体，其愈合率高且并发症极少。本研究进一步加深了我们对MGA皮瓣重建术后患者预后的理解，此前这方面仅限于病例报告和小病例系列。
