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Vascularised Corticoperiosteal Grafts from the Medial Femoral Condyle for Difficult Non-Unions of the Upper LimbFrom the Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa Santander, Spain Correspondence: Dr F. del Piñal, Dr. Med., Calderón de la Barca 16-entlo, E- 39002-Santander, Spain. Tel.: +34 942 364696; fax: +34 942 364702. E-mail:drpinal{at}drpinal.com,pacopinal{at}ono.com. 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.
Key Words: corticoperiosteal grafts • microsurgery • recalcitrant non-union • difficult non-union • long bone complications
Journal of Hand Surgery (European Volume), Vol. 32, No. 2,
135-142 (2007) |
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