From the Division of Plastic Surgery, Department of Surgery, Yale School of Medicine; the Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine; the Division of Plastic Surgery, Department of Surgery, and the Department of Orthopaedic Surgery, University of Pennsylvania Health System; and Plastic and Reconstructive Microsurgery, Careggi University Hospital.
Plast Reconstr Surg. 2021 Apr 1;147(4):613e-622e. doi: 10.1097/PRS.0000000000007778.
The use of free flaps from the medial femoral condyle has grown in popularity and is now a workhorse in the reconstruction of skeletal defects. The utility of this technique has not yet been described for the pediatric patient population. The authors present their series of pediatric patients who underwent surgery using a medial femoral condyle free flap or a variant thereof in skeletal reconstruction and demonstrate the efficacy of this technique in this population.
A multi-institutional retrospective review of patients aged 18 years or younger who required a medial femoral condyle flap for skeletal reconstruction was undertaken. Operative technique, radiographs, and clinical outcomes were recorded. A novel technique (Innocenti) was used to avoid the distal femoral physis in which a Kirschner wire was placed under fluoroscopic guidance just proximal to the growth plate.
Thirteen patients met inclusion criteria, with an average age of 14.7 years (range, 7 to 18 years) and mean follow-up of 28 months (range, 3 to 120 months). Six were skeletally immature at the time of medial femoral condyle harvest, with the last patient having organic bone disease, putting her at risk for pathologic fracture. All 13 patients achieved bony union, and no patients suffered pathologic fractures or physeal injuries; no patients developed length discrepancies.
The authors present the first series of corticocancellous medial femoral condyle free flaps in the pediatric population along with a novel technique to avoid injury to the physis in skeletally immature patients. This technique is effective for a variety of skeletal defects or nonunions and is safe for growing patients without causing physeal arrest or growth disturbance.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
从股骨内侧髁取游离皮瓣的应用越来越普及，现已成为重建骨骼缺损的常用方法。该技术在儿科患者中的应用尚未见报道。作者介绍了他们一系列使用股骨内侧髁游离皮瓣或其变体进行骨骼重建的儿科患者，并展示了该技术在该人群中的疗效。
对需要股骨内侧髁皮瓣进行骨骼重建的 18 岁以下患者进行了多机构回顾性研究。记录手术技术、X 线片和临床结果。采用一种新的技术（Innocenti 技术）来避免股骨远端骨骺，即在骺板近端透视引导下放置克氏针。
13 例患者符合纳入标准，平均年龄 14.7 岁（7-18 岁），平均随访 28 个月（3-120 个月）。6 例在取股骨内侧髁时骨骼未成熟，最后 1 例患有器质性骨病，有发生病理性骨折的风险。所有 13 例患者均达到骨性愈合，无患者发生病理性骨折或骺板损伤；无患者出现长度差异。
作者首次报道了儿童皮质骨化股骨内侧髁游离皮瓣的系列病例，并提出了一种新的技术，以避免骺板在骨骼未成熟患者中受伤。该技术对于各种骨骼缺损或骨不连都有效，对于生长中的患者是安全的，不会导致骺板阻滞或生长障碍。
临床问题/证据水平：治疗性，IV。
