Treatment of tibial nonunions with medial femoral condyle periosteal flaps pedicled with descending genicular artery combined with bone graft / 中华显微外科杂志

ABSTRACT

Objective:To investigate clinical effect of the descending genicular periosteal free flap combined with bone graft in the treatment of tibial nonunions.Methods:From January, 2014 to June, 2018, 15 cases of tibial nonunions were treated with the descending genicular corticoperiosteal free flaps combined with bone graft after soft tissue coverage. All patients had Gustilo III C fracture. In 6 cases, the descending genicular artery of periosteal flap was anastomosed with the branch of anterior tibia artery, 6 cases anastomosed with the branch of posterior tibia artery, other 3 cases had Flow-through anastomosis with the main trunk of anterior tibia artery. The accompanying vein of descending geniculate artery was anastomosed with the vein of anterior tibia or posterior tibia artery. Routine treat- ment, step-by-step functional recovery exercises, monthly X-ray examination were conducted together with close ob- servation of the healing of fracture.Results:All cases were followed-up from 6 to 29 (average, 11) months. Bone u- nion was achieved in 14 cases with the averager time of healing in 5 months. According to the evaluation criteria of Paley fracture healing, 12 cases were excellent, 2 were good and 1 was poor. Fourteen cases were able to take daily normal activities, and 1 case failed to take the daily activities because the fracture was not healed. Six months later, according to the results of Paley functional evaluation, 2 cases were scored excellent, 12 scored good and 1 scored poor.Conclusion:The method of the descending genicular periosteal free flap combined with bone graft in the treatment of tibial nonunions can effectively improve the fracture union rate and reduce the patient treatment time with hidden donor area and simplicity of operation. It is helpful for the patients to take early exercises for the recovery of functions.