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Selected Publication:
Neuwirth, M.
Donor site morbidity after the harvesting of microvascular flaps from the medial and lateral femoral condyle region: Objective, radiologic and patient-reported outcome of a multi-center trial
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medizinische Universität Graz; 2022. pp. 120
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- Authors Med Uni Graz:
- Advisor:
- Kamolz Lars-Peter
- Schintler Michael
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- Abstract:
- Background Due to their consistent anatomy and reconstructive potential, free flaps from the medial and lateral femoral condyle region have become increasingly popular over the last decade. In contrast to the countless scientific reports that have focused on the primary reconstructive potential, there are very few that have evaluated the donor site morbidity (DSM) of these flaps. Since a low flap related morbidity at the donor site ultimately determines the long-term success of every microsurgical donor region, this study aimed to evaluate the DSM of free flaps from the distal femur according to objective and reproducible criteria. Methods This study included 156 patients who had a microvascular cartilage, bone or soft tissue harvest from either the medial or lateral femoral condyle region between 2005 and 2017. A retrospective chart review that focused on all flap characteristics as well as the postoperative course at the donor sites was performed for all patients. In total 97 patients were available for clinical and radiologic long-term follow-up examination. At the follow-up examination, the DSM was assessed according to objective (Knee Society Score; Larson Score; OAK Score;), patient-reported (IKDC Score; KOOS Score; Knee Society Function Score;) and radiologic criteria (Kellgren and Lawrence Score; MRI Osteoarthritis Knee Score – MOAKS). Results In 82.7% of patients (129/156) medial femoral condyle flaps we used, while free flaps from the lateral femoral condyle were harvested in 17.3% (27/156). The flaps included bone or soft tissue in 73.7% (115/156) while osteocartilaginous flaps were used in 26.3% (41/156). The overall complication rate at the donor sites was 9.6% (15/156; major complication rate: 3%) with a significantly higher complication rate for the osteocartilaginous flap subgroup. The median follow-up time was 1529 days (range 248-4810 days). The mean Knee Society Score (94.8 ±10.1), Larson Score (94.5 ±10.1) and OAK Score (95.5 ±6.6) showed nearly unimpaired knee function at the time of follow-up. The overall patient-reported DSM was low (IKDC Score: 86.7 ±17.4; KOOS Score: 89.3 ±17.1; Knee Society Function Score: 97.2 ±7.7). Compared to bone or soft tissue flaps, the osteocartilaginous flap subgroup presented a significantly higher DSM, regardless of the donor site (medial or lateral femoral condyle). Bone flaps did not show any relevant radiologic DSM in the Kellgren and Lawrence scoring system for knee osteoarthritis (Grade 0 or 1: 88.9%, 48/64). Osteocartilaginous flaps showed no significant occurrence of the majority of knee pathologies at the donor knee in the bilateral MRI scans (MOAKS). The obvious cartilage lesions at the donor site did not have a relevant impact on knee function in most of the patients. Conclusion: The DSM for bone and soft tissue flaps from the medial and lateral femoral condyle region is negligible and has no impact on the objective or patient-reported knee function. The DSM for osteocartilaginous flaps can be considered to be low. Compared to bone or soft tissue flaps, the harvesting of these flaps can have some impact on the postoperative knee function.