Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology

作者：John T. Stranix, Merisa Piper, Saïd C. Azoury, Geoffrey M. Kozak, Oded Ben‐Amotz, Keith L. Wapner, L. Scott Levin · 发表于：Foot & Ankle Orthopaedics · 年份：2019 · DOI：10.1177/2473011419884269 · 被引用次数：14 · 研究领域：Reconstructive Surgery and Microvascular Techniques、Foot and Ankle Surgery、Diabetic Foot Ulcer Assessment and Management

Background: Complex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial femoral condyle (MFC) flaps provide vascularized periosteum, skin, and corticocancellous bone. Methods: A retrospective, single-institution cohort study of consecutive MFC flaps performed for complicated hindfoot reconstruction between 2013 and 2019 was reviewed. Radiologic follow-up assessed osseous union and clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Thirty MFC flaps were performed in 28 patients for complex hindfoot pathology. Twenty-seven flaps had adequate clinical and radiographic follow-up (mean 15.8 months). Results: The majority presented with avascular necrosis (83%) and failed prior operations (67%, mean 3.1). Most hindfoot procedures involved arthrodesis (n = 24, 80%); tibiotalocalcaneal (n = 11) and talonavicular (n = 7) most frequently. Mean osseous flap volume was 10.3 cm 3 (range 1.7-18.4 cm 3 ); one flap required takeback for venous congestion but no total flap losses occurred. Primary osseous union was initially achieved in 20 patients (74%, mean 217 days). Six flaps developed interface nonunion; 5 underwent revision arthrodesis and ultimately achieved union in 24/27 flaps (89%, mean 271 days). Risk factors for nonunion were body mass index (BMI) >30 ( P = .017) and prior arthrodesis ( P = .042). Mean AOFAS hindfoot scores increased signif...