Transfer of vascular pedicled free medial femoral condyle bone flap in treatment of scaphoid nonunion / 中华显微外科杂志

Objective:To investigate the clinical effect of the free medial femoral condylar bone flap in treatment of scaphoid nonunion.Methods:From May, 2012 to May, 2016, 15 patients, which were 10 males and 5 females and aged from 18 to 63 (mean 43.5±15.5) years, with scaphoid nonunion were treated with transfer of free medial femoral condyle bone flaps. After debridement of the fractural segment in surgery, the bone flap was transferred to scaphoid and had the bone defect filled. The artery of the bone flap was end-to-side or end-to-end anastomosed to the radial artery. The concomitant vein of the bone flap was end-to-end anastomosed to the concomitant vein of the radial artery. Thirteen patients were treated with the free osteoperiosteal medial femoral condylar graft, and 2 were treated with the free osteochondral medial femoral condylar graft. Fracture healing was evaluated based on X-ray evidence. The clinical effect was evaluated by visual analogue scale (VAS), strength of grip and modified Mayo wrist score. The t-test was used to compare the function between before and after surgery. Results:All patients were entered into a followed-up for an average of 32.5 (8-60) months, 11 of them took the follow-up reviews at the outpatient clinic and 4 via WeChat distanced interviews. All fractures of the 15 patients healed with an average healing time at 12.5 (10-16) weeks. The VAS score decreased from (3.5±1.5) before the surgery to (1.0±1.0) after the surgery. The strength of grip increased from (16.5±4.3) kg before the surgery to (31.5±3.5) kg at the last follow-up review. The modified Mayo wrist score increased from (46.2 ±11.4) before the surgery to (68.5 ±10.8) at the last follow-up review. The wrist function was excellent in 8 patients, good in 6 and fair in 1. There was significant difference in functional evaluation ( P<0.05). Conclusion:The transfer of free medial femoral condylar bone flap is effective in the treatment of scaphoid nonunion. This technique provides both of sufficient blood supply and a structural support for defected scaphoid bone and promotes the healing of fracture. Osteochondral flap transfer may be used as an alternative measure to prevent wrist osteoarthritis and collapse, in the case that there is an avascular necrosis of the proximal pole of the scaphoid. It has an advantage in the treatment of refractory scaphoid nonunion.

Reconstruction of composite bone and soft tissue defect of the hand or foot with the chimeric medial femoral condyle osteofascial free flap / 中华显微外科杂志

Objective:To explore the clinical application of free chimeric medial femoral condyle osteofascial free flap (CMFCOF) in the treatment of traumatic composite bone and soft tissue defect of hand and foot.Methods:Between January, 2015 and March, 2020, 8 patients with traumatic composite bone and soft tissue defect in hand and foot were treated with CMFCOF. Of the 8 patients, there were 6 males and 2 females, with an average age of 41 (range, 24 to 56) years. The causes of injury included 3 of traffic accident, 3 of machine crush and 2 of crush. Two cases had proximal phalanx defect, 3 with metacarpal bone and 3 with metatarsal bone. The time between injury to the flap repair were 2 to 120 (mean, 84) days. The size of bone defect ranged from 2.0 cm×1.2 cm×1.2 cm to 4.4 cm× 3.0 cm×2.3 cm. The soft tissue defect ranged from 2.0 cm×1.4 cm to 5.6 cm×4.5 cm. All bone defects were on the diaphysis, without involvement of joints. Two cases had tendon defect. According to the defect of bone and soft tissue, the CMFCOF was prepared and skin graft was performed on the surface of its fascial flap.Results:The average time of flap harvesting was 53(52-96) minutes. All donor sites were directly closed. All flaps and skin grafts achieved stage I survival. All patients entered 9-16 months of follow-up, with an average of 14.5 months. The average healing time of bone was 7.5 (range, 6-10) weeks. At the last follow-up review, all flaps were not thinned. The function of donor site was restored well, without weight bearing disorder and paraesthesia in the anterior patella area. According to the trial standard of Digit Function Evaluation of the Hand Surgery Society of Chinese Medical Association, 3 patients were rated as excellent, 1 was good and 1 was fair. According to the Maryland foot evaluation criteria, 3 patients were rated as excellent for recovered with normal weight-bearing walking.Conclusion:CMFCOF can achieve satisfactory results in repairing composite bone and soft tissue defect of hand or foot. The flap has the advantages in simple operation, high quality of bone and concealed donor site.

Intraoral anastomosis for maxillary reconstruction with medial femoral condyle periosteal flap: a case report / 华西口腔医学杂志

Maxillary defects result in esthetic and functional defects in patients. Several techniques are available for ma-xillary reconstruction. Herein, we present a case of maxillary reconstruction with medial femoral condyle periosteal flap by intraoral anastomosis. The characteristics of medial femoral condyle periosteal flap and the advantages of intraoral anasto-mosis are introduced.

Free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis / 中华显微外科杂志

Objective To evaluate the outcomes of the free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis and review the utility of this procedure.Methods Eleven cases of old scaphoid fracture with bone necrosis were treated with the free medical femoral condyle bone grafting between Feburay,2013 and May,2015(9 males and 2 females).The average age was 34 years ranged from 27 to 55 years.Six cases were in left wrist,and other 5 cases were in right.Six cases were in waist area,and the other 5 cases were proximal pole nonunion.All cases were evaluated with 3D-CT scan,while humpback deformity were occurred in 6 cases,and avascular necrosis at the proximal pole were occurred in 3 cases.After refreshing the fracture,the free medical femoral condyle bone was transferred to the scaphoid,reduct the scaphoid and fix with the Kirschner wire.An endto-side anastomosis was performed with the bone flap artery and the radial artery,accompanied by the end to end anastomosis of the flap vein and the vein with the radial artery.The plaster was used for 8 weeks.Bone healing was evaluated with X-ray and 3D CT scan.A functional review was performed after the operation and a Mayo wrist scoring test was taken 6 months after the treatment.Results The average followed-up period was 13.1 months(ranged from 9 to 24 months).Bone union were demonstrated in all cases at 13.4 weeks after the operation (ranged from 11 to 18 weeks).Mayo wrist scoring testing showed excellent in 5 cases,good in 4 cases,and fair in 2 cases.Conclusion Free bone flap of medial femoral condyle is constant in vascular anatomy,and is easy to perform with plenty bone graft and less morbidity at donor site.Medial femoral condyle bone flap transplantation based on the descending gennicular vessels is an effective method for treatment of old scaphoid fracture with bone necrosis.

Effect of Anteromedial Portal Entrance Drilling Angle during Anterior Cruciate Ligament Reconstruction: A Three-Dimensional Computer Simulation

PURPOSE: The object of this study was to evaluate entrance angle effects on femoral tunnel length and cartilage damage during anteromedial portal drilling using three-dimensional computer simulation. MATERIALS AND METHODS: Data was obtained from an anatomic study performed using 16 cadaveric knees. The anterior cruciate ligament femoral insertion was dissected and the knees were scanned by computer tomography. Tunnels with different of three-dimensional entrance angles were identified using a computer simulation. The effects of different entrance angles on the femoral tunnel length and medial femoral cartilage damage were evaluated. Specifically, tunnel length and distance from the medial femoral condyle to a virtual cylinder of the femoral tunnel were measured. RESULTS: In tunnels drilled at a coronal angle of 45degrees, an axial angle of 45degrees, and a sagittal angle of 45degrees, the mean femoral tunnel length was 39.5+/-3.7 mm and the distance between the virtual cylinder of the femoral tunnel and the medial femoral condyle was 9.4+/-2.6 mm. The tunnel length at a coronal angle of 30degrees, an axial angle of 60degrees, and a sagittal angle of 45degrees, was 34.0+/-2.9 mm and the distance between the virtual cylinder of the tunnel and the medial femoral condyle was 0.7+/-1.3 mm, which was significantly shorter than the standard angle (p<0.001). CONCLUSION: Extremely low and high entrance angles in both of axial plane and coronal plane produced inappropriate tunnel angles, lengths and higher incidence of cartilage damage. We recommend that angles in proximity to standard angles be chosen during femoral tunnel drilling through the anteromedial portal.

Fat-suppressed 3D SPGR MR Imaging of Articular Cartilage Lesion of Medial Femoral Condyle in Osteoarthritic Knee / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of sagittal fat-suppressed 3D SPGR MR imaging of the osteoarthritic medial femoral condyle in terms of extent and degree of a focal articular cartilage defect of the knee. MATERIALS AND METHODS: The MRI findings (Disler scale) of normal and osteoarthritic medial femoral condyles from 112 knees were prospectively compared with the arthroscopic findings (Jackson staging). The arthroscopic findings were normal in 10 cases, stage I in 26 cases, stage II in 36 cases, stage III in 21 cases and stage IV in 19 cases on arthroscopy. RESULTS: All 10 cases arthroscopy findings were grade 0 in MRI. Among the 26 knees in arthroscopic stage I, only 11 knees (42.3%) showed surface irregularities on MRI that were consistent with grade 1, otherwise grade 2. All cases of arthroscopic stage II showed grade 2 or grade 3. Stage III was grade 3 in all cases on MRI. Among the 19 knees in arthroscopic stage IV, 16 knees (84.2%) with a large defect showed grade 4 on MRI. The sensitivity, specificity and accuracy of the MRI compared with the arthroscopic findings was 97%, 100% and 97.3%, respectively. The weighted kappa index was 0.7194 and the SE (standard error) was 0.053, suggesting significant consistency. CONCLUSION: The sagittal fat-suppressed 3D SPGR MR imaging is valuable for determining the extent and degree of the articular cartilage lesion of the medial femoral condyle in an osteoarthritic knee.