Osteo-periosteal-cutaneous flaps of the medial femoral condyle: a valuable modification for selected clinical situations.

In situations of bony nonunions with poor skin coverage, transplantation of vascularized soft tissue in addition to bone graft is desirable. The use of the corticoperiosteal vascularized bone graft from the medial femoral condyle is well described. There are only anecdotal reports about its use as an osteocutaneous flap. This article presents our results with the use of an osteocutaneous flap from the medial femoral condyle. Between 2004 and 2009, four patients were treated with supracondylar osteocutaneous flaps for bony nonunions (tibia, ankle, calcaneous) with concomitant soft tissue defects. The size of the osseous grafts ranged from 3 x 5 to 6 x 5 cm. The supplying cutaneous vessels were an unnamed perforator of the descending genicular artery (two cases) or the saphenous branch (two cases). The first three cases healed primarily. Bony union was achieved between 32 and 170 days. The follow-up of the fourth case was too short to achieve a bony union. There was no flap loss or surgery-related complications at the donor site. The transfer of free combined vascularized corticoperiosteal-cutaneous flaps seems to be ideally suited for postradiation-induced fractures or chronic nonunions with poor chances of spontaneous healing and a concomitant small skin defect.