The vascularized medial femoral condyle periosteal bone flap for the treatment of recalcitrant bony nonunions

The purpose of this study was to examine our experience with this flap for the treatment of recalcitrant nonunions of the extremities. A retrospective chart review was performed on 11 consecutive patients treated with the medial femoral periosteal bone flap from June 2003 to March 2005. Patient demographics, nonunion characteristics, complications, and long-term outcome based on radiographic and clinical parameters were analyzed. Nine free transfers and 3 pedicled flaps were used for a total of 12 nonunion sites in 11 patients. The average age of the patient population was 49 years (21-64 years). The location of the nonunion sites were femur (n = 4), tibia (n = 2), humerus (n = 3), clavicle (n = 2), and radius (n = 1). The nonunion sites were secondary to traumatic fractures complicated by osteomyelitis (n = 10) and tumor extirpation (n = 2). The time period of nonunion prior to the use of vascularized periosteal bone graft ranged from 10 months to 23 years (median 23 months). All patients had previous attempts at debridement with or without antibiotic bead placement, and all underwent rigid fixation with or without nonvascularized bone grafts prior to vascularized grafting. Following flap placement, 9 (75%) of the nonunion sites healed primarily without complication at an average period of 3.8 months (2-7 months). Two nonunions healed secondarily following hardware modification. There was only 1 flap failure secondary to arterial thrombosis, resulting in a below-knee amputation. The rate of limb salvage was 91%. Donor-site morbidity was minimal, with postoperative seromas occurring in 3 patients.