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J Wrist Surg 2023; 12(04): 288-294
DOI: 10.1055/s-0043-1760737
Special Review: MFC Corticoperiosteal Flap

Medial Femoral Condyle Corticoperiosteal Flap for Failed Total Wrist Fusions

Richard Tee
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
,
Jason N. Harvey
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
2   Orthosport Victoria, Richmond, Melbourne, Victoria, Australia
,
Stephen K. Tham
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
3   Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
4   Victorian Hand Surgery Associates, Fitzroy, Melbourne, Victoria, Australia
,
Eugene T. Ek 
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
3   Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
5   Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
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Abstract

Background Recalcitrant nonunion following total wrist arthrodesis is a rare but challenging problem. Most commonly, in the setting of failed fusion after multiple attempts of refixation and cancellous bone grafting, the underlying cause for the failure is invariably multifactorial and is often associated with a range of host issues in addition to poor local soft-tissue and bony vascularity. The vascularized medial femoral condyle corticoperiosteal (MFC-CP) flap has been shown to be a viable option in a variety of similar settings, which provides vascularity and rich osteogenic progenitor cells to a nonunion site, with relatively low morbidity. While its utility has been described for many other anatomical locations throughout the body, its use for the treatment of failed total wrist fusions has not been previously described in detail in the literature.

Methods In this article, we outline in detail the surgical technique for MFC-CP flap for the management of recalcitrant aseptic nonunions following failed total wrist arthrodesis. We discuss indications and contraindications, pearls and pitfalls, and potential complications of this technique.

Results Two illustrative cases are presented of patients with recalcitrant nonunions following multiple failed total wrist fusions.

Conclusion When all avenues have been exhausted, a free vascularized corticoperiosteal flap from the MFC is a sound alternative solution to achieve union, especially when biological healing has been compromised. We have been able to achieve good clinical outcomes and reliable fusion in this difficult patient population.

Keywords

medial femoral condyle flap - MFC - nonunion - wrist - radiocarpal - fusion - arthrodesis - corticoperiosteal flap - bone graft


Publication History

Received: 16 April 2022

Accepted: 03 December 2022

Article published online:
20 January 2023

© 2023. Thieme. All rights reserved.

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