Free Medial Femoral Condyle Flap for Phalangeal and Metacarpal Bone Reconstruction

Background. The medial femoral condyle (MFC) flap is a versatile option for the reconstruction of small osseous defects; however, its use in reconstructing phalanges and metacarpal bones in the hand has not been widely reported. Patients and Methods. Between 2013 and 2020, 13 consecutive patients with osseous defects of phalanges or metacarpals reconstructed with free MFC flaps were included. Demographics, defects characteristics, flap design, and clinical course were recorded. Outcomes measured included time to bone healing, total active motion percentage (TAM%), pulp pinch power, and patient-reported outcome measures using the Michigan Hand Questionnaire (MHQ) and National Health Service (NHS) friend and family test. Results. A total of 14 MFC flaps were used to reconstruct 16 bone defects. The median age was 32 (range, 21–36) years. A total of 9 phalanges and 7 metacarpals were reconstructed. The median bone gap size was 1.5 cm (range, 1.2–2.1 cm), and most were segmental bone defects (14/16). Bone union was achieved in all the cases within a median of 7.3 (5.5–9.5) weeks. Median pulp pinch power was 71% (67–80) of contralateral side, and the median TAM% was 76% (67–76). The affected hands scored lower than the unaffected hands in MHQ total scores (p=0.109), function (p=0.002), and satisfaction (p=0.024) domains. However, all patients or patient caregivers were likely to recommend the procedure if someone would need similar care or treatment. Conclusions. In this series, the free MFC proved to be a reliable method for bone reconstruction of the hand, providing also a one-stage solution for multiple bone defects in conjunction with soft tissue loss.