TY - JOUR

T1 - Sequential chimeric medial femoral condyle and anterolateral thigh flow-through flaps for one-stage reconstructions of composite bone and soft tissue defects

T2 - Report of three cases

AU - Henn, Dominic

AU - Abouarab, Mohamed H

AU - Hirche, Christoph

AU - Hernekamp, Jochen F

AU - Schmidt, Volker J

AU - Kneser, Ulrich

AU - Kremer, Thomas

N1 - © 2017 Wiley Periodicals, Inc.

PY - 2017/10

Y1 - 2017/10

N2 - Small recalcitrant non-unions with poor perfusion require reconstruction with vascularized bone flaps. Cases with concomitant large soft tissue defects are especially challenging, since vascularized soft tissue transfer is often indicated and distant microvascular anastomoses may be required. We introduce a sequential chimeric free flap composed of a medial femoral condyle corticoperiosteal flap anastomosed to an anterolateral thigh flow-through flap (MFC-ALT flap) and report its use for reconstruction of small non-unions with concomitant large soft tissue defects in three exemplary patients. Two female and one male patients ages 39-58 years suffered from composite bone and soft tissue defects of the lower extremity and clavicle caused by tumor resection and postoperative radiation resp. infected tibial pilon fracture. The sizes of the soft tissue defects ranged from 15-23 × 4.5-6 cm and the sizes of the bone defects ranged from 1.5-4 × 2-4 cm. Defect reconstructions were performed in all cases with sequential chimeric MFC-ALT flaps with sizes ranging from 2-4 × 1.6-4 cm for the MFC and 21-23 × 7-8 cm for the ALT skin paddles. Functional reconstructions were achieved in all cases resulting in stable unions and soft tissue coverage enabling the patients to bear full weight without assistance on 5-months follow-up. Postoperative course was uneventful and complications were restricted to a small skin necrosis at the suture line in one case. MFC-ALT flaps may be a safe, and effective procedure for one-stage reconstructions of small, irregularly shaped bone defects with concomitant large soft tissue loss or surrounding instable scarring, particularly in cases of recalcitrant non-unions after radiation exposure.

AB - Small recalcitrant non-unions with poor perfusion require reconstruction with vascularized bone flaps. Cases with concomitant large soft tissue defects are especially challenging, since vascularized soft tissue transfer is often indicated and distant microvascular anastomoses may be required. We introduce a sequential chimeric free flap composed of a medial femoral condyle corticoperiosteal flap anastomosed to an anterolateral thigh flow-through flap (MFC-ALT flap) and report its use for reconstruction of small non-unions with concomitant large soft tissue defects in three exemplary patients. Two female and one male patients ages 39-58 years suffered from composite bone and soft tissue defects of the lower extremity and clavicle caused by tumor resection and postoperative radiation resp. infected tibial pilon fracture. The sizes of the soft tissue defects ranged from 15-23 × 4.5-6 cm and the sizes of the bone defects ranged from 1.5-4 × 2-4 cm. Defect reconstructions were performed in all cases with sequential chimeric MFC-ALT flaps with sizes ranging from 2-4 × 1.6-4 cm for the MFC and 21-23 × 7-8 cm for the ALT skin paddles. Functional reconstructions were achieved in all cases resulting in stable unions and soft tissue coverage enabling the patients to bear full weight without assistance on 5-months follow-up. Postoperative course was uneventful and complications were restricted to a small skin necrosis at the suture line in one case. MFC-ALT flaps may be a safe, and effective procedure for one-stage reconstructions of small, irregularly shaped bone defects with concomitant large soft tissue loss or surrounding instable scarring, particularly in cases of recalcitrant non-unions after radiation exposure.

KW - Adult

KW - Bone Transplantation/methods

KW - Female

KW - Femoral Fractures/diagnostic imaging

KW - Follow-Up Studies

KW - Fracture Fixation, Internal/methods

KW - Graft Survival

KW - Humans

KW - Male

KW - Middle Aged

KW - Multiple Trauma/diagnostic imaging

KW - Perforator Flap/blood supply

KW - Plastic Surgery Procedures/methods

KW - Recovery of Function

KW - Risk Assessment

KW - Sampling Studies

KW - Soft Tissue Injuries/diagnosis

KW - Thigh/surgery

KW - Tibial Fractures/diagnostic imaging

KW - Transplantation Chimera

KW - Wound Healing/physiology

U2 - 10.1002/micr.30209

DO - 10.1002/micr.30209

M3 - Journal article

C2 - 28767176

VL - 37

SP - 824

EP - 830

JO - International Journal of Microsurgery

JF - International Journal of Microsurgery

SN - 0738-1085

IS - 7

ER -