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these cases. In the case of small bony defects (< 6 cm),     REFERENCES
          the vascularized composite osteomyocutaneous flap
          from medial femoral condyle can fill the dead space of   1.   Rahmanian-Schwarz A, Spetzler V, Amr A, Pfau M, Schaller HE, Hirt B.
          bone and soft tissue. It also minimizes the risk of deep   A composite osteomusculocutaneous free fl ap from the medial femoral
          tissue infection. By increasing the vascularity and the   condyle for reconstruction of complex defects.  J  Reconstr Microsurg
                                                                  2011;27:251-60.
          blood supply of the composite flap, limb salvage can be   2.   Bürger HK, Windhofer C, Gaggl AJ, Higgins JP. Vascularized medial femoral
          obtained with a single surgical procedure. Vascularized   trochlea osteocartilaginous fl ap reconstruction of proximal pole scaphoid
          bone grafting can be combined with muscle tissue and    nonunions. J Hand Surg Am 2013;38:690-700.
          a skin island, and thus can be used to solve complex   3.   Iorio ML, Masden DL, Higgins JP. The limits of medial femoral condyle
                                                                  corticoperiosteal fl aps. J Hand Surg Am 2011;36:1592-6.
          problems in cases with bone and soft tissue defects.  4.   Doi K, Sakai K. Vascularized periosteal bone graft from the supracondylar
          The current study showed 100% of AB, 62.5% of MB, and   region of the femur. Microsurgery 1994;15:305-15.
          70.3% of SB branches come from the DGA. It allows the   5.   Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft. Plast
                                                                  Reconstr Surg 1991;87:290-8.
          use of the medial femoral condylar bone flap, and this   6.   Van Dijck C, Mattelaer B, De Degreef I, De Smet L. Arterial anatomy of the
          can be combined with muscle or skin in some cases.      free vascularised corticoperiosteal graft from the medial femoral condyle.
          However, preoperative vascular assessment of this       Acta Orthop Belg 2011;77:502-5.
          flap with an angiogram is very important due to the   7.   Yamamoto H, Jones DB Jr, Moran SL, Bishop AT, Shin AY. The arterial
                                                                  anatomy of the medial femoral condyle and its clinical implications. J Hand
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          and SBs. This result differs from previous reports which   8.   Doi K, Hattori Y. Vascularized bone graft from the supracondylar region of
          studied fewer specimens; Iorio  et  al.  identified the SB   the femur. Microsurgery 2009;29:379-84.
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          in 11 of 12 specimens (92%). Rahmanian-Schwarz  et  al. [1]  9.   Bakri K, Shin AY, Moran SL. The vascularized medial femoral corticoperiosteal
                                                                  flap for reconstruction of bony defects within the upper and lower
          studied 21 specimens, and in 91.5%, the DGA split into   extremities. Semin Plast Surg 2008;22:228-33.
          three branches: AB, MB, and SB. Yamamoto et al.  showed   10.  Jones DB Jr, Bürger H, Bishop AT, Shin AY. Treatment of scaphoid waist
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          that the SB was detected in 79% of their 19 specimens,   nonunions with an avascular proximal pole and carpal collapse. A comparison
          branching off a common trunk with AB. Van Dijck et al.    of two vascularized bone grafts. J Bone Joint Surg Am 2008;90:2616-25.
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          found that the SB was present in 14 (41%) of the 27 cases.  11.  Jones DB Jr, Moran SL, Bishop AT, Shin AY. Free-vascularized medial femoral
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                                                                  Surg 2010;125:1176-84.
          The current study demonstrates that the size and length   12.  Kakar S, Duymaz A, Steinmann S, Shin AY, Moran SL. Vascularized medial
          of the vessels supplying the medial femoral condyle are   femoral condyle corticoperiosteal fl aps for the treatment of recalcitrant
          sufficient for a vascularized bone flap. This graft is very   humeral nonunions. Microsurgery 2011;31:85-92.
          helpful in the treatment of chronic nonunion and small   13. De Smet L. Treatment of non-union of forearm bones with a free vascularised
          bone gap reconstruction. Although many studies have     corticoperiosteal fl ap from the medial femoral condyle. Acta Orthop Belg
                                                                  2009;75:611-5.
          reported the viability of the vascularized composite   14.  Del Piñal F, García-Bernal FJ, Regalado J, Ayala H, Cagigal L, Studer A.
          osteomyocutaneous flap from the medial femoral condyle,   Vascularised corticoperiosteal grafts from the medial femoral condyle for
          a careful preoperative vascular assessment is essential   diffi cult non-unions of the upper limb. J Hand Surg Eur Vol 2007;32:135-42.
          secondary to the considerable anatomical variations in the   15.  Rodríguez-Vegas JM, Delgado-Serrano PJ. Corticoperiosteal fl ap in the
          different branches of the DGA. Further clinical studies will   treatment of nonunions and small bone gaps: technical details and expanding
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          be required to clearly define the success of this composite   16.  Iorio ML, Masden DL, Higgins JP. Cutaneous angiosome territory of the
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          ACKNOWLEDGMENTS
                                                               How to cite this article: Le  Thua  T, Bui D, Pham D, Le  V,
                                                               DeMey A, Boeckx W. Anatomic variability of the vascularized
          The authors would like to thank the Department of Anatomy, Ho   composite osteomyocutaneous fl ap from the medial femoral condyle:
          Chi Minh University of Medicine and Pharmacy, Vietnam. We are   an anatomical study. Plast Aesthet Res 2014;1:85-8.
          grateful to Doctors LÊ Nghi Thanh Nhan, Paul Luu, Nguyen Van
          Phung, Tran Thiet Son and Peter Scougall for their excellent help   Source of Support: Nil, Confl ict of Interest: None declared.
          and support.                                         Received: 11-05-2014; Accepted: 23-07-2014























            88                                                             Plast Aesthet Res || Vol 1 || Issue 3 || Dec 2014
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