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J Reconstr Microsurg 2022; 38(08): 593-603
DOI: 10.1055/s-0041-1740130
Original Article

Free Medial Femoral Condyle Flap for Reconstruction of Scaphoid Nonunion: A Systematic Review

Kiane J. Zhou
1   Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia
,
David J. Graham
2   Department of Orthopaedic Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
,
David Stewart
3   Department of Hand & Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
,
Richard D. Lawson
3   Department of Hand & Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
,
Brahman S. Sivakumar
3   Department of Hand & Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
4   Department of Orthopaedic Surgery, Hornsby Ku-Ring-Gai Hospital, Hornsby, New South Wales, Australia
› Author Affiliations Funding The authors received no financial support for the research, authorship, and/or publication of this article.
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Abstract

Background The free medial femoral condyle (MFC) bone flap is an attractive option for reconstruction of scaphoid nonunion utilizing vascularized bone to augment bony healing, especially in cases of failed prior treatment or osteonecrosis. This review aims to determine the role and reliability of the free MFC flap for treatment of scaphoid nonunion.

Methods A search of electronic databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles examining free MFC bone flaps for treatment of scaphoid nonunion were included for analysis. Outcomes of interest included flap failure, postoperative union rate, time to union, carpal indices, functional outcomes, and complications.

Results Twelve articles met the inclusion criteria. A total of 262 patients underwent free MFC flaps for treatment of scaphoid nonunion. The most common site of nonunion was the proximal pole of the scaphoid with 47% of patients receiving prior attempts at operative management. Overall bony union rate was 93.4% with a mean time to union of 15.6 weeks. There were no flap failures reported. Improvements in carpal indices including scapholunate (p < 0.0004), radiolunate (p < 0.004), lateral interscaphoid angles (p < 0.035), and revised carpal ratio height (p < 0.024) were seen postoperatively. Visual analog scale improved postoperatively from 6.5 to 2.3 (p < 0.015). Postoperative complications were observed in 69 cases (26.3%), with 27 patients (10.3%) requiring further operative intervention. However, no major donor or recipient site morbidity was appreciated.

Conclusion MFC flaps provide a highly versatile and reliable option for reconstruction of scaphoid nonunion with excellent bony union rates and acceptable complication rates. The present literature suggests that MFC reconstruction of scaphoid nonunion restores radiocarpal anatomy and improves wrist function without causing significant donor or recipient site morbidity.

Keywords

free flap - medial femoral condyle - vascularized bone graft - scaphoid nonunion - microvascular surgery - hand surgery


Publication History

Received: 26 April 2021

Accepted: 26 September 2021

Article published online:
14 December 2021

© 2021. Thieme. All rights reserved.

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