Selçuk Üniversitesi Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, 42250 Selçuklu, Konya, Türkiye.
Jt Dis Relat Surg. 2024 Aug 14;35(3):574-582. doi: 10.52312/jdrs.2024.1730.
The objective of this study was to determine the role and reliability of the free medial femoral condyle (MFC) flap (MFCF) in demanding foot and ankle reconstruction procedures.
A search of the MEDLINE, PubMed, and Embase electronic databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines between January 2008 and September 2023. Articles concerning free MFC bone flaps for reconstruction of the foot and ankle regions were included. Outcomes of interest included flap failure, complications, union rate, time to union, and functional scores.
Twenty studies involving 131 patients met the inclusion criteria. The most common clinical indications for the free MFCF were nonunion, avascular necrosis, and osteomyelitis. The most common sites of nonunion were tibiotalar arthrodesis (50%) and subtalar arthrodesis (33%). Overall, the bony union rate was 93.1%, with a mean time to union of 14.6±0.1 weeks. There were no flap failures reported. Postoperative complications were observed in 39 (29.7%) cases (e.g., delayed donor site wound healing, flap debulking, medial condyle osteonecrosis, and donor site numbness), with 21 (16%) patients requiring further operative intervention. No major donor or recipient site morbidity occurred, except for one case.
Free MFCFs offer a versatile and dependable choice for cases of foot and ankle reconstruction, displaying favorable rates of bone fusion and acceptable complication rates. Existing literature indicates that MFC reconstruction in the foot and ankle is not associated with significant morbidity at the donor or recipient sites. The pooled data demonstrated a 93% success rate in achieving bone fusion in the foot and ankle region, supporting the view that it can be considered another option of treatment.
本研究旨在确定游离股骨内侧髁（MFC）瓣（MFCF）在足部和踝关节重建手术中的作用和可靠性。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南，对 MEDLINE、PubMed 和 Embase 电子数据库进行了搜索，检索时间为 2008 年 1 月至 2023 年 9 月。纳入涉及用于足部和踝关节区域重建的游离 MFC 骨瓣的文章。感兴趣的结果包括皮瓣失败、并发症、愈合率、愈合时间和功能评分。
20 项研究共纳入 131 例患者，符合纳入标准。游离 MFCF 的最常见临床适应证为骨不连、缺血性坏死和骨髓炎。最常见的不愈合部位是距下关节融合（50%）和距舟关节融合（33%）。总体而言，骨性愈合率为 93.1%，平均愈合时间为 14.6±0.1 周。无皮瓣失败报告。术后并发症在 39 例（29.7%）患者中观察到（例如，供区伤口愈合延迟、皮瓣削薄、内侧髁骨坏死和供区麻木），21 例（16%）患者需要进一步手术干预。除 1 例外，主要供区或受区无明显并发症。
游离 MFCF 为足部和踝关节重建提供了一种通用且可靠的选择，其骨融合率高，并发症发生率可接受。现有文献表明，MFC 在足部和踝关节重建中不会导致供区或受区明显的发病率。汇总数据显示，足部和踝关节区域骨融合成功率为 93%，支持将其视为另一种治疗选择的观点。
