Abstract
Fracture healing is a complex process and many factors change the local biology of
the fracture and reduce the physiologic repair process. Since 1991 the free vascularised
corticoperiosteal graft has been proposed to treat nonunions. In this study we compare
the healing rate and the healing time of the free vascularised corticoperiosteal graft
harvested from medial femoral condyle versus the traditional cancellous bone graft
from the iliac crest combined with other biologic or pharmacologic factors. We performed
a retrospective cohort study. The main measures of outcomes were the rate of bone
union and the mean healing time from surgery. The authors performed 10 free vascularised
corticoperiosteal grafts in the cohort A and 10 patients received traditional cancellous
bone graft plus other biologic or pharmacologic treatment in the same period in the
cohort B. The mean follow up in cohort A was 18.6 months with a healing rate of 100%
(10/10). In cohort B the mean follow up was 22.5 month with a healing rate of 90%.
The mean time to obtain union (healing time) in the group that was treated with the
free flap procedure was significantly shorter, 3.2 months versus a mean time of 8.8
months in the other group. Some studies describe a high healing rate of recalcitrant
nonunions with treatments different from vascularized bone flaps: it is difficult
to compare the results of vascularized bone transfers with the results of other case
series. Our groups are very homogeneous even if it is difficult to define correct
inclusion criteria because there is still no agreement about what is defined a recalcitrant
or difficult nonunion, and the number of trials of previous surgery before to perform
a vascularized free flap. Even if our study cohort is small, we have demonstrated
that the MFCCF generally seems to give a better healing chance with a shorter healing
time compared to other treatments.
Keywords
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Article info
Publication history
Published online: October 21, 2019
Footnotes
This paper is part of a Supplement supported by the European Federation of Societies of Microsurgery (EFSM) and the Serbian Society for Reconstructive Microsurgery (SSRM).
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© 2019 Elsevier Ltd. All rights reserved.
