Vascularised corticoperiosteal grafts from the medial femoral condyle for difficult non-unions of the upper limb.
The vascularised corticoperiosteal graft was introduced by Sakai and Doi, in 1991, as a means to achieve bony union under unfavourable conditions. We present our experience with this vascularised graft, taken from the femoral condyle, in six patients with difficult non-unions (5) or other bony problems (1) in the upper limb. In five cases, a long bone defect--two humeral, two ulnar and one radial--was involved. All had had between three and seven previous operations. Two of the non-unions were secondary to infection. The others had had conventional grafting on two or three previous occasions each. In the sixth case, a corticoperiosteal graft was used to promote healing in a combined carpometacarpal and intercarpal dislocation with a very poor bed. All of the grafts survived without complications and all of the bones healed radiologically in less than three months. Three patients achieved a normal range of motion and two obtained a functional range of motion with only slight limitations. The carpometacarpal arthrodesis was healed soundly at five weeks.
Del Piñal
F
F
From the Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa Santander, Spain. drpinal@drpinal.com
García-Bernal
F J
FJ
Regalado
J
J
Ayala
H
H
Cagigal
L
L
Studer
A
A
D000293:Adolescent; D000328:Adult; D050280:Arm Bones / Q000293:injuries / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D005269:Femur / Q000637:transplantation*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D010521:Periosteum / Q000098:blood supply / Q000637:transplantation*; D013524:Surgical Flaps / Q000098:blood supply*