The Institute for Advanced Reconstruction, Egg Harbor Township, NJ, USA.
Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.
Foot Ankle Int. 2020 Jun;41(6):728-734. doi: 10.1177/1071100720917158. Epub 2020 Apr 24.
In patients with avascular necrosis (AVN) of the talus in the precollapse stage unresponsive to conservative measures, joint preservation should be considered. Good results have previously been reported for vascularized bone grafting. The medial femoral condyle (MFC) free flap has recently been introduced, which consists of corticoperiosteal bone. We present a novel surgical technique using a periosteal-only MFC (pMFC) free flap in the treatment of talus AVN.
We retrospectively reviewed all pMFC free flaps performed from 2016 to 2018 in the precollapse stage of talus AVN. Surgical management included an ankle arthroscopy, talus core decompression, and ipsilateral pMFC free flap to the talus. Foot and Ankle Ability Measure (FAAM)-Activities of Daily Living (ADL) and visual analog scale (VAS) pain scores were evaluated, and pre- and postoperative imaging studies were assessed by a musculoskeletal-trained radiologist for all patients. Six pMFC free flaps in 5 patients were included in this case series. AVN etiology included idiopathic, posttraumatic, and sepsis-related treatment. All patients were female with an average age of 44.2 (range, 37-67) years. Average postoperative follow-up was 16.9 (range, 6-28) months.
Pre- to postoperative FAAM-ADL, ADL single assessment numeric evaluation, and VAS scores showed statistically significant improvement ( < .039). No reoperations or flap complications were observed. There was 1 minor complication, which included postoperative paresthesias at the pMFC harvest site. Postoperative x-rays showed no subsequent collapse, and magnetic resonance imaging (MRI) illustrated progressive improvement of bone marrow edema, decreased surrounding areas of AVN, and decreased joint effusion when compared to preoperative MRI.
The pMFC free flap is a novel modification of a previously described technique, which appears to have similar results compared to the traditional MFC free flap. It was safe and effective in the short term with excellent clinical and radiographic outcomes.
Level IV, case series.
在塌陷前期对保守治疗无反应的距骨缺血性坏死（AVN）患者，应考虑关节保护。血管化骨移植的效果先前已有报道。最近引入了内侧股骨髁（MFC）游离皮瓣，它由皮质骨和骨膜组成。我们介绍了一种使用单纯骨膜内侧股骨髁（pMFC）游离皮瓣治疗距骨 AVN 的新手术技术。
我们回顾性分析了 2016 年至 2018 年间在距骨 AVN 塌陷前期接受 pMFC 游离皮瓣治疗的所有患者。手术治疗包括踝关节镜检查、距骨芯减压和同侧 pMFC 游离皮瓣移植至距骨。采用足踝能力测量（FAAM）-日常生活活动（ADL）和视觉模拟评分（VAS）疼痛评分评估，所有患者的术前和术后影像学检查均由经过肌肉骨骼培训的放射科医生进行评估。本病例系列纳入 5 例 6 例 pMFC 游离皮瓣。AVN 的病因包括特发性、外伤性和与感染相关的治疗。所有患者均为女性，平均年龄 44.2（范围 37-67）岁。平均随访时间为 16.9（范围 6-28）个月。
FAAM-ADL、ADL 单项评估数值评估和 VAS 评分的术前至术后均有统计学显著改善（<0.039）。无再次手术或皮瓣并发症。仅发生 1 例轻微并发症，即皮瓣供区术后出现感觉异常。术后 X 线未见进一步塌陷，与术前 MRI 相比，MRI 显示骨髓水肿逐渐改善，AVN 周围区域缩小，关节积液减少。
pMFC 游离皮瓣是一种对先前描述的技术的新改良，与传统的 MFC 游离皮瓣相比，其结果似乎相似。在短期内，它是安全有效的，具有良好的临床和影像学结果。
IV 级，病例系列。
