The Versatility Of The Medial Femoral Condyle Flap: One Surgeon’s Experience
Stephanie Thibaudeau, MD, Patrick Gerety, MD, Nikolas Kazmers, MD, Scott Levin, MD, FACS.
University of Pennsylvania, Philadelphia, PA, USA.
Purpose: The medial femoral condyle (MFC) flap has arguably become the flap of choice for treatment of small to medium size critical bony defects. This paper aims to describe the versatility of the MFC in treating a variety of bony defects.
Methods: A retrospective chart review was performed from 2009 to 2014 on all patients who underwent free MFC flaps.
Results: Twenty-two patients were identified: 17 upper and 6 lower extremity bony reconstructions. The upper extremites included 7 scaphoid non-unions, 3 lunate avascular necrosis, 2 ulnar non-union, 2 proximal humerus reconstructions, and 2 metacarpal non-unions, 1 clavicle. The lower extremity reconstructions included 5 for talus and 1 for navicular. The average was 44 years (18-64) and average BMI was 29.3±6.59. In 15 cases, hardware was used to stabilize the bone flap, and in the remaining cases suture or impaction was used to immobilize the flap. Average follow-up was 28.4 months ± 23.24. Ultimately, 77% (17 of 22) demonstrated complete or partial radiologic bony union. Of the five who had non-union, two were symptomatically improved. Notably amongst scaphoid patients union was 86%. A significant correlation was found between higher BMI and non-union (p<0.05).
Discussion:For these complex bone defects, we have obtained a satisfactory union rate despite a morbid patient population. The MFC flap has the advantages of a reliable pedicle, optional skin paddle, and minimal donor morbidity.
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