Mattos David, Ko Jason H, Iorio Matthew L
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Division of Plastic and Reconstructive Surgery, Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Microsurgery. 2019 Jan;39(1):32-38. doi: 10.1002/micr.30368. Epub 2018 Sep 3.
Osteomyelitis of the wrist is rare but destructive. Subsequent bone defects often require vascularized bone for successful healing. Recent literature has pointed to the successful use of the medial femoral condylar (MFC) flap for difficult non-unions, yet it has not been specifically described for wrist fusion. We present our experience with this technique for limited and complete wrist arthrodesis.
We reviewed 4 cases of radiocarpal bone loss from osteomyelitis. All cases utilized debridement of nonviable tissues, and at least 6 weeks of intravenous antibiotics, followed by vascularized bone grafting with a MFC flap. The flap was based on the horizontal periosteal branch of the descending geniculate artery, and utilized to directly bridge the bony defects following resection.
Three patients healed primarily, and 1 patient required secondary cancellous bone grafting to reach union. One patient required revision of the donor site closure. None of the patients had a recurrence of infection or other complications. Average follow up was 8.5 months after reconstruction. Average time to union was 11.5 weeks. Three patients demonstrated full composite fist, and 1 patient had incomplete finger range of motion following several flexor and extensor tendon grafts.
These cases illustrate the use of the MFC in wrist arthrodesis after osteomyelitis defects. In all cases, there was complete union in a short time, no recurrence of infection, and low donor-site morbidity.
腕关节骨髓炎罕见但具有破坏性。随后的骨缺损通常需要带血管骨才能成功愈合。最近的文献指出，股骨内侧髁（MFC）皮瓣已成功用于治疗困难的骨不连，但尚未专门描述其用于腕关节融合术。我们介绍了我们使用该技术进行有限和完全腕关节融合术的经验。
我们回顾了4例因骨髓炎导致的桡腕骨丢失病例。所有病例均采用了对无活力组织的清创术，并进行了至少6周的静脉抗生素治疗，随后采用MFC皮瓣进行带血管骨移植。该皮瓣以膝降动脉的水平骨膜支为蒂，用于在切除后直接桥接骨缺损。
3例患者一期愈合，1例患者需要二次松质骨移植才能达到骨愈合。1例患者需要对供区闭合进行修复。所有患者均未出现感染复发或其他并发症。重建后平均随访8.5个月。平均骨愈合时间为11.5周。3例患者握拳完全，1例患者在进行了几次屈指肌腱和伸指肌腱移植后手指活动范围不完全。
这些病例说明了MFC皮瓣在骨髓炎缺损后腕关节融合术中的应用。在所有病例中，均在短时间内实现了完全骨愈合，无感染复发，供区并发症发生率低。
