Kaiser Dominik, Levin L Scott
Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Foot Ankle Orthop. 2023 Aug 25;8(3):24730114231191135. doi: 10.1177/24730114231191135. eCollection 2023 Jul.
Recalcitrant or persistent nonunions of the metatarsophalangeal (MTP) joint occur following failed MTP surgery for MTP fusion, failed MTP prosthesis, for hallux rigidus or due to infection and erosion. A deficient soft tissue envelope and compromised vascular supply of tissues in this region compound further attempts to salvage the great toe and preserve function. The medial femoral condyle (MFC) free flap provides vascularized corticocancellous bone and periosteum and has been successfully used for a variety of complex hindfoot and ankle pathologies. We present an additional indication with a small cohort study demonstrating its use in persistent nonunions of the first MTP joint.
A retrospective review was completed of all MFC flaps used for revision of failed first MTP joint fusion from January 2019 to November 2022. Demographic information, comorbidities, as well as clinical and radiologic follow-up was obtained from the patient charts.
Three patients were included with MTP nonunion and an average of 7.5 (range, 5-11) failed prior surgeries. Mean age at index surgery was 50 (range, 46-57) years. An osseous union was achieved in all patients after 82 (range, 75-88) days. Hardware removal was possible after 81 (range, 55-98) days. Mean follow-up was 17 (range, 5-31) months. We note a 100% flap success rate without returns to the operating room. The lengths of the bone flaps were 2 to 4 cm, the volumes were 8 to 12 cm. Fixation was performed with 1 intramedullary K-wire. The recipient vessel in all patients was the dorsalis pedis artery or a tributary thereof. All arterial anastomoses were performed under the operating microscope.
The MFC free flap is a reasonable option for salvage of complex recalcitrant or persistent nonunions of the first MTP joint. More prospective long-term studies with functional outcomes are necessary to confirm these findings.
Level IV, retrospective case series.
跖趾（MTP）关节顽固性或持续性骨不连发生于MTP融合手术失败、MTP假体植入失败、拇僵硬或因感染及侵蚀之后。该区域软组织包膜不足及组织血供受损，使进一步挽救拇趾并保留功能的尝试变得更加复杂。股内侧髁（MFC）游离皮瓣可提供带血管的皮质松质骨和骨膜，已成功用于多种复杂的后足和踝关节病变。我们通过一项小型队列研究提出其另一应用指征，即展示其在第一跖趾关节持续性骨不连中的应用。
对2019年1月至2022年11月期间用于翻修失败的第一跖趾关节融合术的所有MFC皮瓣进行回顾性研究。从患者病历中获取人口统计学信息、合并症以及临床和影像学随访资料。
纳入3例跖趾关节骨不连患者，先前平均手术失败7.5次（范围5 - 11次）。初次手术时的平均年龄为50岁（范围46 - 57岁）。所有患者在82天（范围75 - 88天）后实现骨愈合。81天（范围55 - 98天）后可行内固定取出。平均随访17个月（范围5 - 31个月）。我们注意到皮瓣成功率为100%，无需再次手术。骨瓣长度为2至4厘米，体积为8至12立方厘米。用1根髓内克氏针进行固定。所有患者的受区血管为足背动脉或其分支。所有动脉吻合均在手术显微镜下进行。
MFC游离皮瓣是挽救第一跖趾关节复杂顽固性或持续性骨不连的合理选择。需要更多具有功能结局的前瞻性长期研究来证实这些发现。
四级，回顾性病例系列。
