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首页> 外文期刊>Foot & Ankle Orthopaedics >Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology
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Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology

机译：内侧股骨髁自由襟翼复杂脚和踝关节病理学

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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 cm3 (range 1.7-18.4 cm3); 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 significantly from 52.3 preoperatively to 70.7 postoperatively (P .001). Subscore analysis demonstrated significant improvement in postoperative pain scores from 14.2 to 27.3 out of 40 (P .001). Conclusion: The MFC free flap provided vascularized bone for complicated foot and ankle reconstruction with relatively low donor site morbidity, promising osseous union results, and improved functional outcomes. Level of Evidence: Level IV, retrospective case series.
机译：背景：复杂的后脚病理学可能受益于血管化骨瓣重建而不是传统的骨移植技术。内侧股骨髁（MFC）襟翼提供血管化骨膜，皮肤和皮质毛细管。方法：综述了2013年至2019年在2013年至2019年间对复杂的Hindfoot重建进行的连续MFC襟翼的回顾性的单机构队列研究。用美国矫形脚和踝关节（AOFAS）Hindfoot得分评估了放射学后续评估的骨质联合和临床结果。在28例患者中进行了三十MFC襟翼，用于复杂的Hindfoot病理学。二十七片襟翼有足够的临床和射线照相随访（平均15.8个月）。结果：大多数大多数患有缺血性坏死（83％），并发症失败（67％，平均值3.1）。大多数后脚手术涉及关节瘤（n = 24,80％）; Tibiotalogalcaneal（n = 11）和爪子（n = 7）最常。平均骨盘体积为10.3 cm3（范围1.7-18.4 cm3）;一个皮瓣需要收集静脉充血，但没有发生总皮瓣损失。原发性骨质联盟最初在20名患者中获得（74％，平均217天）。六个襟翼开发的界面不沉积; 5经过修订关节和最终达到24/27襟翼的联盟（89％，平均271天）。非阴性的危险因素是体重指数（BMI）> 30（p = .017）和先前关节瘤（p = .042）。平均AOFAS Hindfoot分数从术前至70.7分的52.3显着增加到70.7（p <.001）。子核速度分析表现出术后疼痛评分的显着改善，从40分中的14.2％到27.3（p <.001）。结论：MFC自由翼片为复杂的脚和踝部重建提供血管化骨，具有相对较低的供体部位发病率，有前途的骨元结果，以及改善的功能结果。证据级别：第四级，回顾性案例系列。

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