Department of Orthopaedics and Traumatology and Hand Surgery Konya, Selcuk University, Konya, Turkey.
Department of Orthopaedics and Traumatology, Konya Beyhekim Training and Research Hospital, Konya, Turkey.
Sci Rep. 2023 Nov 21;13(1):20326. doi: 10.1038/s41598-023-47432-x.
Periosteal or osteoperiosteal medial femoral condyle (MFC) flaps may be good options for atrophic nonunion. The aim of this study was to evaluate the effectiveness and safety of pedicled MFC flap in the treatment of recalcitrant femur nonunion without bone defect. Thirteen patients (11 male and 2 female), who suffered recalcitrant femur nonunion and were treated with pedicled osteoperiosteal MFC flap between January 2014 and April 2018, were included in this study. Patient files were reviewed retrospectively. Atrophic or recalcitrant 2/3 distal femoral nonunion were the indications for this clinical procedure. Demographics and operative data, flap size, visual analog scale (VAS) score, time to union, and complications were evaluated. A total of 13 patients underwent femur nonunion treatment with MFC flap after an average of 3.4 previous surgical procedures. The median age was 34 (Q1: 32.5, Q3:43) years old. The mean flap size was 4.3 × 6.4 cm, all nonunions healed in a median 5 months (Q1: 4.5, Q3: 6). There were an intraoperative knee medial collateral ligament injury in a patient, hematoma in a patient, and seroma in two patients. The median length of the follow-up was 40 months (Q1: 30, Q3: 47). There wasn't any additional complication in long-term follow-up. Functional outcomes were satisfactory. The median preoperative VAS score was 7 (Q1: 6, Q3: 9.5), decreasing to 1 (Q1: 0, Q3: 1) at the 6-month follow-up, and further reducing to 0 (Q1: 0, Q3: 1) at the 24-month follow-up. The nonunion period ranged from 6 to 18 months. The pedicled MFC flap is a good option for recalcitrant femur nonunion where larger vascularized flaps are not warranted. It is easy to harvest, does not require microvascular anastomosis, is effective, and offers minimal donor site morbidity.
带蒂骨膜-骨膜股骨内侧髁瓣可能是治疗萎缩性骨不连的良好选择。本研究旨在评估带蒂 MFC 皮瓣治疗无骨缺损的难治性股骨骨不连的有效性和安全性。2014 年 1 月至 2018 年 4 月期间，我们采用带蒂骨膜-骨膜股骨内侧髁瓣治疗 13 例难治性股骨骨不连患者，男 11 例，女 2 例。回顾性分析患者病历。该临床操作的适应证为萎缩或难治性 2/3 股骨远端骨不连。评估患者的一般资料和手术数据、皮瓣大小、视觉模拟评分（VAS）、愈合时间和并发症。13 例患者平均经历 3.4 次手术治疗后，采用 MFC 皮瓣治疗股骨骨不连。患者年龄中位数为 34 岁（Q1：32.5，Q3：43）。皮瓣大小中位数为 4.3×6.4cm，所有骨不连均在中位数 5 个月（Q1：4.5，Q3：6）愈合。1 例患者术中内侧副韧带损伤，1 例患者血肿，2 例患者血清肿。中位随访时间为 40 个月（Q1：30，Q3：47）。长期随访中无其他并发症。功能结果满意。术前 VAS 评分中位数为 7（Q1：6，Q3：9.5），6 个月随访时降至 1（Q1：0，Q3：1），24 个月随访时进一步降至 0（Q1：0，Q3：1）。骨不连时间为 6～18 个月。带蒂 MFC 皮瓣是治疗较大血管化皮瓣不适宜的难治性股骨骨不连的良好选择。该皮瓣易于获取，无需吻合血管，疗效确切，供区并发症少。
