Frederick Durden, MD
Thomas Scharschmidt, MD
James Boehmler, MD
Ohio State University Medical Center Department of Plastic and Reconstructive Surgery
Presenter: Frederick Durden, MD
Author Category: Attending
Presentation Category: Clinical
Abstract Category: General Reconstruction
How does this presentation meet the established conference educational objectives?
This presentaion addresses the conference educational objectives by discussion current concepts in lower extremity reconstructive surgery. Specifically, the presentation discussed the value of the medial epicondyle flap in osseous reconstruction.
How will your presentation be used by practicing physicians in the audience?
The audience will use this presentation to augment their knowledge of lower extremity reconstuction.
Osseous reconstruction of the lower extremity can be significantly complicated by nonunion, malunion, fracture or partial osseous flap loss. In the case of infection, radiation, chemotherapy, extensive necrosis, poor vasculature and/or chronically established callus, vascularized tissue transfer may be required. Vascularized osseous reconstruction can be performed with free flaps such as the fibula, iliac crest, scapula, humerus and rib. Lack of viable periosteum or improper orientation of the periosteum may contribute to failure seen in allograft reconstructions of sarcoma patients. In comparison to these standard bone flaps which are large, can carry significant morbidity, and have incorrect periosteal polarity, the medial epicondyle corticoperiosteal flap, because of its osteoinductive ability, can potentially treat small nonunions or osseous loss. This case presentation discusses the use of the medial epicondyle flap in the attempted salvage of cadaveric femur allograft fracture after previous chondrosarcoma resection and reconstruction. Gross and histological evaluation were performed to determine the amount of osseous growth under the medial epicondyle flap into the native femur and allograft as compared to surrounding areas not covered with the periosteal flap. There is debate as to how the medial epicondyle corticoperiosteal flap increases osseous production. In this case there was increased osseous production in areas covered by the medial epicondyle corticoperiosteal flap which supports its potential use in complicated bone and allograft reconstructions where nonunion, malunion, or fracture is a factor.
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