Functional chimeric perforator flap of medial femoral condyle for osteochondral and soft tissue reconstruction in hand and foot joints_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Mingwu ¹ , LI Yanfeng ¹ , GAO Yang ² , ZHANG Kai ² , ZHAO Zhiwei ¹ , WEI Kuo ³ ,  CHEN Jia ³

1. Department of Hand and Microsurgery Orthopedics Center, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou Henan, 450047, P. R. China;
2. Department of Orthopedics, Zhengzhou 460 Hospital, Zhengzhou Henan, 450042, P. R. China;
3. Department of Orthopedics, No.988 Hospital of Joint Logistics Support Force of Chinese PLA, Zhengzhou Henan, 450007, P. R. China;

Corresponding author：

CHEN Jia, Email: chenjia153@163.com

Keywords：

Functional chimeric perforator flap; medial femoral condyle; bone and cartilage defect; repair and reconstruction

DOI：

10.7507/1002-1892.202506115

Video：

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Objective To evaluate the effectiveness of free medial femoral condyle (MFC) functional chimeric perforator flap (FCPF) transplantation in reconstructing joint function by repairing concomitant osteochondral defects and soft tissue loss in hand and foot joints. Methods A retrospective analysis was performed on 6 patients (5 males, 1 female; mean age 33.4 years, range 21-56 years) with traumatic osteochondral joint defects and associated tendon, nerve, and soft tissue defects treated between January 2019 and May 2025. Defect locations included metacarpal heads (n=2), metacarpophalangeal joint (n=1), first metatarsal head (n=1), base of first proximal phalanx (n=1), and talar head (n=1), with soft tissue defects in all cases. Osteochondral defect sizes ranged from 1.5 cm×1.2 cm×0.7 cm to 4.0 cm×0.6 cm×0.6 cm, and skin defects ranged from 4 cm × 3 cm to 13 cm × 4 cm. The stage Ⅰ treatment included debridement, antibiotic-loaded bone cement filling of bone-cartilage defects, fracture internal fixation, and coverage with vacuum sealing drainage. Stage Ⅱ involved harvesting a free MFC- FCPF included an osteochondral flap (range of 1.5 cm×1.2 cm×0.7 cm to 4.0 cm×0.6 cm×0.6 cm), gracilis and/or semitendinosus tendon grafts (length of 4-13 cm), saphenous nerve graft (length of 3.5-4.0 cm), and a perforator skin flap (range of 6 cm×4 cm to 14 cm×6 cm), each with independent vascular supply. The flap was transplanted to reconstruct joint function. Donor sites were closed primarily or with skin grafting. Flap survival was monitored postoperatively. Radiographic assessment was used to evaluate bone/joint healing. At last follow-up, the joint function recovery was assessed using the upper limb function evaluation standard of the Chinese Medical Association Hand Surgery Society for the hand, the Maryland Foot Score for the foot, and International Knee Documentation Committee (IKDC) Score for the knee. Results All 6 FCPF survived completely, with primary healing of wounds and donor sites. All patients were followed up 6-44 months (mean, 23.5 months). The flaps at metacarpophalangeal joint in 1 case and at ankle joint in 1 case were treated with degreasing repair because of their bulky appearance, while the other flaps had good appearance and texture. At 3 months after operation, the VAS score of recipient area was 0-2, with an average of 0.7; at last follow-up, the VAS score of the donor area was 0-1, with an average of 0.3. According to the Paley fracture healing scoring system, the osteochondral healing of all the 6 patients was excellent. The range of motion of the metacarpophalangeal joint in 3 cases was 75%, 90%, and 100% of contralateral side respectively, the range of motion of the metatarsophalangeal joint in 2 cases was 65% and 95% of contralateral side respectively, and the range of motion of the ankle joint in 1 case was 90% of contralateral side. The hand function was evaluated as excellent in 2 cases and good in 1 case according to the upper limb function evaluation standard of the Chinese Medical Association Hand Surgery Society, and the foot function was evaluated as excellent in 2 cases and fair in 1 case according to the Maryland foot function score of 93, 91, and 69, respectively. The IKDC score of 6 knees was 91-99, with an average of 95.2. Conclusion The free MFC-FCPF enables precise anatomical joint reconstruction with three-dimensional restoration of tendon, nerve, capsule, and soft tissue defects, effectively restoring joint function and improving quality of life.

1.	Wei W, Dai H. Articular cartilage and osteochondral tissue engineering techniques: Recent advances and challenges. Bioact Mater, 2021, 6(12): 4830-4855.
2.	Tsiklin IL, Shabunin AV, Kolsanov AV, et al. In vivo bone tissue engineering strategies: Advances and prospects. Polymers (Basel), 2022, 14(15): 3222. doi: 10.3390/polym14153222.
3.	Chen R, Pye JS, Li J, et al. Multiphasic scaffolds for the repair of osteochondral defects: Outcomes of preclinical studies. Bioact Mater, 2023, 27: 505-545.
4.	Dimitriou R, Jones E, McGonagle D, et al. Bone regeneration: current concepts and future directions. BMC Med, 2011, 9: 66. doi: 10.1186/1741-7015-9-66.
5.	Keller M, Kastenberger T, Anoar AF, et al. Clinical and radiological results of the vascularized medial femoral condyle graft for scaphoid non-union. Arch Orthop Trauma Surg, 2020, 140(6): 835-842.
6.	张凯, 戚彩, 谢峻, 等. 带血管的股骨内侧髁骨软骨嵌合组织瓣修复跖骨头复合组织缺损一例. 中华显微外科杂志, 2021, 44(2): 232-234.
7.	Scampa M, Mégevand V, Martineau J, et al. Medial femoral condyle free flap: A systematic review and proportional meta-analysis of applications and surgical outcomes. Plast Reconstr Surg Glob Open, 2024, 12(4): e5708. doi: 10.1097/GOX.0000000000005708.
8.	Paley D, Catagni MA, Argnani F, et al. Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res, 1989(241): 146-165.
9.	潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
10.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
11.	Collins NJ, Misra D, Felson DT, et al. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken), 2011, 63 Suppl 11(0 11): S208-S228.
12.	Zhou L, Gjvm VO, Malda J, et al. Innovative tissue-engineered strategies for osteochondral defect repair and regeneration: Current progress and challenges. Adv Healthc Mater, 2020, 9(23): e2001008. doi: 10.1002/adhm.202001008.
13.	Yang J, Zhang YS, Yue K, et al. Cell-laden hydrogels for osteochondral and cartilage tissue engineering. Acta Biomater, 2017, 57: 1-25.
14.	Hurst JM, Steadman JR, O’Brien L, et al. Rehabilitation following microfracture for chondral injury in the knee. Clin Sports Med, 2010, 29(2): 257-265.
15.	Hinckel BB, Gomoll AH. Autologous chondrocytes and next-generation matrix-based autologous chondrocyte implantation. Clin Sports Med, 2017, 36(3): 525-548.
16.	Thomas AC, Hubbard-Turner T, Wikstrom EA, et al. Epidemiology of posttraumatic osteoarthritis. J Athl Train, 2017, 52(6): 491-496.
17.	Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft. Plast Reconstr Surg, 1991, 87(2): 290-298.
18.	Silva GB, Vellosa MT, Cho AB, et al. Medial femoral condyle corticoperiosteal flap: Anatomic study. Acta Ortop Bras, 2018, 26(3): 179-182.
19.	Andrade RG, Bufáiçal HG, Oliveira LA, et al. Contribution to the anatomical study of the corticoperiosteal flap of the medial femoral condyle. Rev Bras Ortop, 2015, 44(5): 404-407.
20.	Oh C, Pulos N, Bishop AT, et al. Intraoperative anatomy of the vascular supply to the medial femoral condyle. J Plast Reconstr Aesthet Surg, 2019, 72(9): 1503-1508.
21.	高华. 国人正常股骨内外侧髁股胫接合线曲率半径的研究. 南京: 南京中医药大学, 2009.
22.	姚玲, 李川, 李军, 等. 数字化技术测量掌指关节部分数据及分析. 西南国防医药, 2020, 30(10): 911-914.
23.	张树明, 丁自海, 张成进, 等. 吻合血管的跖骨头移植替代月骨的应用解剖. 中华显微外科杂志, 1998, 21(1): 46-48.
24.	刘育杰, 于龙华, 任胜全, 等. 嵌合游离股骨内侧髁骨筋膜瓣修复手或足部长段骨及软组织复合组织缺损. 中华显微外科杂志, 2021, 44(5): 521-525.
25.	Guzzini M, Lanzetti RM, Perugia D, et al. The treatment of long bones nonunions of upper limb with microsurgical cortico-periosteal free flap. Injury, 2017, 48 Suppl 3: S66-S70.
26.	Hachisuka H, Ishibashi S, Shimose S, et al. Vascularized origami medial femoral condyle flap for finger joint reconstruction. Plast Reconstr Surg, 2023, 152(6): 1297-1301.
27.	Katz RD, Parks BG, Higgins JP. The axial stability of the femur after harvest of the medial femoral condyle corticocancellous flap: a biomechanical study of composite femur models. Microsurgery, 2012, 32(3): 213-218.
28.	Guzzini M, Lupariello D, Argento G, et al. Vascular and bone regeneration of the donor site after corticoperiosteal flap from the medial femoral condyle. Hand (N Y), 2022, 17(2): 366-372.

1. Wei W, Dai H. Articular cartilage and osteochondral tissue engineering techniques: Recent advances and challenges. Bioact Mater, 2021, 6(12): 4830-4855.
2. Tsiklin IL, Shabunin AV, Kolsanov AV, et al. In vivo bone tissue engineering strategies: Advances and prospects. Polymers (Basel), 2022, 14(15): 3222. doi: 10.3390/polym14153222.
3. Chen R, Pye JS, Li J, et al. Multiphasic scaffolds for the repair of osteochondral defects: Outcomes of preclinical studies. Bioact Mater, 2023, 27: 505-545.
4. Dimitriou R, Jones E, McGonagle D, et al. Bone regeneration: current concepts and future directions. BMC Med, 2011, 9: 66. doi: 10.1186/1741-7015-9-66.
5. Keller M, Kastenberger T, Anoar AF, et al. Clinical and radiological results of the vascularized medial femoral condyle graft for scaphoid non-union. Arch Orthop Trauma Surg, 2020, 140(6): 835-842.
6. 张凯, 戚彩, 谢峻, 等. 带血管的股骨内侧髁骨软骨嵌合组织瓣修复跖骨头复合组织缺损一例. 中华显微外科杂志, 2021, 44(2): 232-234.
7. Scampa M, Mégevand V, Martineau J, et al. Medial femoral condyle free flap: A systematic review and proportional meta-analysis of applications and surgical outcomes. Plast Reconstr Surg Glob Open, 2024, 12(4): e5708. doi: 10.1097/GOX.0000000000005708.
8. Paley D, Catagni MA, Argnani F, et al. Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res, 1989(241): 146-165.
9. 潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
10. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
11. Collins NJ, Misra D, Felson DT, et al. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken), 2011, 63 Suppl 11(0 11): S208-S228.
12. Zhou L, Gjvm VO, Malda J, et al. Innovative tissue-engineered strategies for osteochondral defect repair and regeneration: Current progress and challenges. Adv Healthc Mater, 2020, 9(23): e2001008. doi: 10.1002/adhm.202001008.
13. Yang J, Zhang YS, Yue K, et al. Cell-laden hydrogels for osteochondral and cartilage tissue engineering. Acta Biomater, 2017, 57: 1-25.
14. Hurst JM, Steadman JR, O’Brien L, et al. Rehabilitation following microfracture for chondral injury in the knee. Clin Sports Med, 2010, 29(2): 257-265.
15. Hinckel BB, Gomoll AH. Autologous chondrocytes and next-generation matrix-based autologous chondrocyte implantation. Clin Sports Med, 2017, 36(3): 525-548.
16. Thomas AC, Hubbard-Turner T, Wikstrom EA, et al. Epidemiology of posttraumatic osteoarthritis. J Athl Train, 2017, 52(6): 491-496.
17. Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft. Plast Reconstr Surg, 1991, 87(2): 290-298.
18. Silva GB, Vellosa MT, Cho AB, et al. Medial femoral condyle corticoperiosteal flap: Anatomic study. Acta Ortop Bras, 2018, 26(3): 179-182.
19. Andrade RG, Bufáiçal HG, Oliveira LA, et al. Contribution to the anatomical study of the corticoperiosteal flap of the medial femoral condyle. Rev Bras Ortop, 2015, 44(5): 404-407.
20. Oh C, Pulos N, Bishop AT, et al. Intraoperative anatomy of the vascular supply to the medial femoral condyle. J Plast Reconstr Aesthet Surg, 2019, 72(9): 1503-1508.
21. 高华. 国人正常股骨内外侧髁股胫接合线曲率半径的研究. 南京: 南京中医药大学, 2009.
22. 姚玲, 李川, 李军, 等. 数字化技术测量掌指关节部分数据及分析. 西南国防医药, 2020, 30(10): 911-914.
23. 张树明, 丁自海, 张成进, 等. 吻合血管的跖骨头移植替代月骨的应用解剖. 中华显微外科杂志, 1998, 21(1): 46-48.
24. 刘育杰, 于龙华, 任胜全, 等. 嵌合游离股骨内侧髁骨筋膜瓣修复手或足部长段骨及软组织复合组织缺损. 中华显微外科杂志, 2021, 44(5): 521-525.
25. Guzzini M, Lanzetti RM, Perugia D, et al. The treatment of long bones nonunions of upper limb with microsurgical cortico-periosteal free flap. Injury, 2017, 48 Suppl 3: S66-S70.
26. Hachisuka H, Ishibashi S, Shimose S, et al. Vascularized origami medial femoral condyle flap for finger joint reconstruction. Plast Reconstr Surg, 2023, 152(6): 1297-1301.
27. Katz RD, Parks BG, Higgins JP. The axial stability of the femur after harvest of the medial femoral condyle corticocancellous flap: a biomechanical study of composite femur models. Microsurgery, 2012, 32(3): 213-218.
28. Guzzini M, Lupariello D, Argento G, et al. Vascular and bone regeneration of the donor site after corticoperiosteal flap from the medial femoral condyle. Hand (N Y), 2022, 17(2): 366-372.

Chinese Journal of Reparative and Reconstructive Surgery

Latest ArticlesFunctional chimeric perforator flap of medial femoral condyle for osteochondral and soft tissue reconstruction in hand and foot joints

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