Applications of the medial femoral condyle free flap for foot and ankle reconstruction

Nicholas T. Haddock, Hassan Alosh, Mark E. Easley, L. Scott Levin, Keith L. Wapner

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Avascular necrosis (AVN) or persistent nonunion occurs in situations of poor vascular supply. Some specific situations that plague the foot and ankle surgeon are talus nonunion, talus AVN, navicular AVN, and failed ankle arthrodesis with bone loss. The medial femoral condyle (MFC) flap has emerged as a popular source of vascularized corticocancelous bone. We present a series of cases demonstrating the versatility of the MFC flap in complex foot and ankle pathology. Methods: A retrospective review was completed of all MFC flaps used in the foot and ankle over the past 5 years. Five patients were identified (average age 48). Surgical indications included talar AVN and ankle arthritis, talar nonunion, and navicular AVN. All patients had undergone conventional bone grafting techniques, which failed, prior to being treated with a MFC free flap; this series of patients did not possess significant medical comorbidities. Fixation techniques included compression screw fixation, plate osteosynthesis, or fine wire external fixation. The average follow-up was 20 months (range 8 to 40 months). Results: There was a 100% flap success rate with no returns to the operating room for thrombosis. The volume of the bone flaps was 5.6 cm3 (range 1 cm3 to 12 cm3). The average follow-up time was 20 months (range 8 to 40 months). All cases resulted in union, and full weight bearing status was achieved at a mean of 23.8 weeks (range 10 to 52 weeks) postoperatively. Conclusions: Vascularized bone transfer in the form of the MFC free flap was a valuable method for foot and ankle reconstruction. The MFC flap provided an alternative for those defects that were smaller then 3 cm in length. In our experience, for small bone defects requiring vascularized bone, the MFC flap is currently the ideal donor location supplanting the iliac crest.

Original languageEnglish (US)
Pages (from-to)1395-1402
Number of pages8
JournalFoot and Ankle International
Volume34
Issue number10
DOIs
StatePublished - Oct 2013

Fingerprint

Free Tissue Flaps
Thigh
Ankle
Foot
Bone and Bones
Necrosis
Talus
Plague
Bone Transplantation
Arthrodesis
Weight-Bearing
Operating Rooms
Arthritis
Blood Vessels
Comorbidity
Thrombosis

Keywords

  • ankle arthrodesis
  • bone flap
  • medial femoral condyle
  • navicular revascularization
  • subtalar arthrodesis
  • talus nonunion

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Applications of the medial femoral condyle free flap for foot and ankle reconstruction. / Haddock, Nicholas T.; Alosh, Hassan; Easley, Mark E.; Levin, L. Scott; Wapner, Keith L.

In: Foot and Ankle International, Vol. 34, No. 10, 10.2013, p. 1395-1402.

Research output: Contribution to journalArticle

Haddock, Nicholas T. ; Alosh, Hassan ; Easley, Mark E. ; Levin, L. Scott ; Wapner, Keith L. / Applications of the medial femoral condyle free flap for foot and ankle reconstruction. In: Foot and Ankle International. 2013 ; Vol. 34, No. 10. pp. 1395-1402.
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abstract = "Background: Avascular necrosis (AVN) or persistent nonunion occurs in situations of poor vascular supply. Some specific situations that plague the foot and ankle surgeon are talus nonunion, talus AVN, navicular AVN, and failed ankle arthrodesis with bone loss. The medial femoral condyle (MFC) flap has emerged as a popular source of vascularized corticocancelous bone. We present a series of cases demonstrating the versatility of the MFC flap in complex foot and ankle pathology. Methods: A retrospective review was completed of all MFC flaps used in the foot and ankle over the past 5 years. Five patients were identified (average age 48). Surgical indications included talar AVN and ankle arthritis, talar nonunion, and navicular AVN. All patients had undergone conventional bone grafting techniques, which failed, prior to being treated with a MFC free flap; this series of patients did not possess significant medical comorbidities. Fixation techniques included compression screw fixation, plate osteosynthesis, or fine wire external fixation. The average follow-up was 20 months (range 8 to 40 months). Results: There was a 100{\%} flap success rate with no returns to the operating room for thrombosis. The volume of the bone flaps was 5.6 cm3 (range 1 cm3 to 12 cm3). The average follow-up time was 20 months (range 8 to 40 months). All cases resulted in union, and full weight bearing status was achieved at a mean of 23.8 weeks (range 10 to 52 weeks) postoperatively. Conclusions: Vascularized bone transfer in the form of the MFC free flap was a valuable method for foot and ankle reconstruction. The MFC flap provided an alternative for those defects that were smaller then 3 cm in length. In our experience, for small bone defects requiring vascularized bone, the MFC flap is currently the ideal donor location supplanting the iliac crest.",
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KW - subtalar arthrodesis

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