Tips and Tricks for a Successful Bone Reconstruction with the Corticoperiosteal/Periosteal Flap from the Medial Femoral Condyle

Introduction: The corticoperiosteal flap from the medial femoral condyle has become the workhorse in the management of recalcitrant nonunions with vascularized periosteum.

Methodology and Material: Based on two publications on the topic and a total of 56 periosteal bone reconstructions performed, the author reviews the tips and tricks for a successful bone reconstruction with vascularized periosteum from the medial femoral condyle. The author reviews, step by step, the surgical procedure: debridement, bone stabilization, bone graft refinement and flap procedure

Results: With a personal experience of 56 bone reconstructions with vascularized periosteum and a 98% success rate, the author has not found significant major and/or long lasting complications or sequelae associated with the procedure.

Conclusions: The corticoperiosteal flap from the femoral condyle is an excellent source of vascularization and osteogenic stimulus to the non-union site and highly effective in the management of persistent nonunions and small bone gaps. When needed, a structural corticocancellous strut from the iliac crest (along with a stable internal fixation) provides the greatest stability and the possibility of a prompt rehabilitation and functional recovery. Although not statistically significant due to the small sample size, our experience support the idea that both periosteal and corticoperiosteal flaps from the medial femoral condyle are effective, when associated with a bone graft, in the treatment of recalcitrant nonunions with small gaps. The corticoperiosteal/periosteal flap has succeeded in revascularizing these highly demanding grafts and allowing an extremely high union rate.