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Joint Diseases and
Related Surgery
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Original Article · Open access

Free vascularized medial femoral condyle periosteal flaps in the ankle and foot region: A narrative review

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Selim Safali

Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, University of Leeds, UK Department of Orthopedics and Traumatology, Selçuk University Faculty of Medicine, Konya, Türkiye

ORCID: 0000-0001-9010-4169

Michael G Kontakis

Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, University of Leeds, UK Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden

ORCID: 0000-0002-1502-1221

Peter V Giannoudis

Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, University of Leeds, UK NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK

ORCID: 0000-0002-5205-7696

Abstract

Objectives: The objective of this study was to determine the role and reliability of the free medial femoral condyle (MFC) flap (MFCF) in demanding foot and ankle reconstruction procedures.

Materials and methods: A search of the MEDLINE, PubMed, and Embase electronic databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines between January 2008 and September 2023. Articles concerning free MFC bone flaps for reconstruction of the foot and ankle regions were included. Outcomes of interest included flap failure, complications, union rate, time to union, and functional scores.

Results: Twenty studies involving 131 patients met the inclusion criteria. The most common clinical indications for the free MFCF were nonunion, avascular necrosis, and osteomyelitis. The most common sites of nonunion were tibiotalar arthrodesis (50%) and subtalar arthrodesis (33%). Overall, the bony union rate was 93.1%, with a mean time to union of 14.6±0.1 weeks. There were no flap failures reported. Postoperative complications were observed in 39 (29.7%) cases (e.g., delayed donor site wound healing, flap debulking, medial condyle osteonecrosis, and donor site numbness), with 21 (16%) patients requiring further operative intervention. No major donor or recipient site morbidity occurred, except for one case.

Conclusion: Free MFCFs offer a versatile and dependable choice for cases of foot and ankle reconstruction, displaying favorable rates of bone fusion and acceptable complication rates. Existing literature indicates that MFC reconstruction in the foot and ankle is not associated with significant morbidity at the donor or recipient sites. The pooled data demonstrated a 93% success rate in achieving bone fusion in the foot and ankle region, supporting the view that it can be considered another option of treatment.

Declarations

Ethics Committee Approval

This narrative review is a literature review, and ethical committee approval is not required. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Informed Consent

Since this study is a review of the existing literature, patient consent is not required.

Author Contributions

Data collection and analysis: S.S.; Compiling and writing the manuscript: M.K.; Planning and writing the manuscript: P.G.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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