Donor site morbidity after microvascular medial femoral condylar flap procurement for facial reconstruction.

The medial femoral condyle (MFC) flap is considered an ideal graft for bone reconstructions. This study was performed to evaluate donor site knee joint function and scar appearance after MFC flap procurement. Adult patients who had undergone facial reconstruction with an MFC flap between March 2011 and March 2017 at the University Hospital Salzburg were enrolled. Knee function was assessed postoperatively using two validated orthopaedic scores: Tegner Lysholm Knee Scoring Scale (TL) and Knee Society Score (KSS); both range from 0 to 100 (100 being no impairment). Scars were evaluated using the Patient and Observer Scar Assessment Scale (POSAS) (range 6-60). Thirty-eight patients were enrolled. The average postoperative TL score was 95.68 (range 66-100). The mean KSS clinical examination and function scores were 96.8 (range 58-100) and 97.11 (range 60-100), respectively. Flap type (osteocutaneous vs. non-osteocutaneous) did not correlate with TL or KSS scores. KSS and TL scores showed no association with vascular pedicle length or transplant volume. The average POSAS patient and observer scores were 6.84 and 15.24, respectively. POSAS observer scores were significantly higher for osteocutaneous flaps than for non-osteocutaneous flaps. The MFC flap causes minimal donor site morbidity. No knee joint instability or range of motion limitation was found. Postoperative TL and KSS scores indicated excellent knee function.

[Semilunar bone necrosis (Kienböck's disease) - first clinical results after free microvascularised bone graft from the distal femur]. / Die idiopathische Mondbeinnekrose (M. Kienböck) - Erste Ergebnisse nach operativer Therapie mit einem freien mikrovaskulären Femurtransplantat.

BACKGROUND: Idiopathic aseptic osseous necrosis of the semilunar bone is also called Kienböck's disease after Robert Kienböck who firstly described this disease. The clinical picture is characterised by a stage-like course. Internationally the classification according to Lichtman and Ross has achieved the most acceptance. The actual therapy is dependent on the present disease stage. Basically, various pressure-relieving operative procedures are possible, on the other hand operative interventions via revascularisation represent a therapeutic option. In the case of advanced disease only, "salvage procedures" like partial or total arthrodesis of the wrist are available. However, such operations are associated with marked restrictions in the range of motion and unsatisfactory clinical results. The present study reports on our clinical experiences after operative therapy for aseptic lunar bone necrosis via free microvascularised bone grafting from the distal femur. PATIENTS AND METHODS: Between 01/2005 and 12/2010 nineteen patients with idiopathic semilunar bone necrosis underwent operative care via a free microvascularised bone graft from the distal femur at our institution. 16 patients could be re-evaluated retrospectively on follow-up examination at 26.5 months (range 16-42) on average after primary care. Mean age was 43.8 years (range 24-66). Clinical assessment was performed according to the Mayo wrist score (MWS) and the disabilities of the arm, shoulder and hand (DASH) score. Radiological assessment was performed according to the classification of Lichtman and Ross. RESULTS: On operative treatment 14 patients were graded II at least according to the Lichtman classification. An additional 2 patients showed a stage III B disease. The median operative time amounted to 254 min (range 233-362). The postoperative course did not reveal any complications, in particular concerning wound healing. Only one patient (6 %) showed no trabecular integration between the inserted graft and the lunar bone. Clinical evaluation according to the MWS with a median of 82.5 points (65-100), and the DASH score with a median of 29.5 points (24.2-102.2) documented good to excellent clinical results. CONCLUSION: Operative treatment for idiopathic semilunar bone necrosis via a free microvascularised bone graft from distal femur achieves good clinical results without an increase of postoperative complications even with advanced stages of the disease. However, long-term results and larger patient samples are required to prove the final success of this operative technique.

Reconstruction of the nose with a new double flap technique: microvascular osteocutaneous femur and microvascular chondrocutaneous ear flap--first clinical results.

This study describes a new microvascular flap combination from the medial femur and ear to reconstruct the nose after subtotal resection and presents the first clinical results. In four patients a squamous cell carcinoma of the nose was registered. In three patients this was diagnosed for the first time while in the fourth patient it was the second relapse after two resections and local flap surgery. In every case, tumour resection ended up in an extended defect of the nose, cheek and upper lip region. For skeletal reconstruction and the inner lining of the nose, a microvascular osteocutaneous femur flap was used. After reconstructing the nasal skeleton, the remaining defect was covered by a microvascular composite flap from the left ear and preauricular region. Both flap pedicles were anastomosed to the facial vein and artery. In every case, the flaps healed without complications. There was no tumour relapse. 12 months after reconstruction, minor surgical corrections were made. The patients showed a satisfying functional and aesthetic result. The combination of a microvascular osteocutaneous femur flap and a microvascular ear flap can be used successfully for reconstructing the nose after subtotal resection.

A combined superficial inferior epigastric artery flap and vascularized iliac crest flap in the reconstruction of extended composite defects of the posterior mandible and adjacent soft tissue: first clinical results.

The technique of posterior facial reconstruction using a combination of a superficial inferior epigastric artery (SIEA) flap and a microvascular iliac crest flap (deep circumflex iliac artery (DCIA) flap) is described. 12 cases are reported. The patients had unilateral squamous cell carcinoma of the posterior mandible affecting parts of the soft palate and tonsil region or the posterior cheek. In all patients unilateral neck dissection, resection of the posterior and lateral mandible, was performed. Reconstruction was carried out during primary surgical therapy, followed by postoperative radiotherapy. A flap combination of a SIEA and a DCIA flap was used. There were no problems with pedicle length or anastomoses. There was no flap loss or severe postoperative complications. All patients had good aesthetic and functional results. One patient had distant metastases 2 years postoperatively. All other patients were free of tumour relapse or metastases within 12-58 months of follow up. The SIEA flap and vascularized iliac bone flap combination is useful in reconstructing the posterior face. The iliac bone flap is well suited for posterior mandible reconstruction and the SIEA flap for reconstruction of the soft palate, lateral pharyngeal wall and cheek. Both flaps are harvested from the same donor site.

[Free microvascular transfer of segmental corticocancellous femur for treatment of avascular scaphoid necrosis]. / Das freie mikrovaskuläre Femurtransplantat zur Behandlung der avaskulären Kahnbeinnekrose.

Successful treatment of scaphoid non-union with avascular necrosis of the proximal poles and humpback deformity with carpal collapse is one of the main problems in reconstructive hand surgery. Vascularised bone transfer is one of the most successful techniques for treating these problems. 15 patients with avascular necrosis and non-union of the scaphoid were treated by a microvascular reanastomosed corticocancellous transplant from the distal medial femur. In all patients the success of the microvascular bone transfer was examined by MRI and conventional radiographs immediately, 6 weeks, 3, 6 and 12 months postoperatively. The transplant vitality, signs of reunion and carpal configuration were registered. Furthermore, the Mayo wrist score was employed for clinical evaluation. All transplants remained vital during the follow-up period of one year. Pseudoarthrosis was treated successfully in every case. In 14 cases there was a significant increase of the Mayo wrist score and in one case there was no difference before and after surgery. The microvascular transfer of corticocancellous femur resulted in a high rate of complete healing of scaphoid pseudoarthrosis and correction of the carpal relation.