[Free vascularised medial femoral trochlea flap : Indication and technique].

BACKGROUND: Avascularity of fragments is a common problem in treatment of scaphoid nonunion. Therefore, vascularised bone grafts have gained increasing importance. Especially the free vascularised femoral trochlea flap has become the subject of special interest because of its particular characteristics in the last few years.
OBJECTIVES: Indications for and the technique of free vascularised corticocancellous as well as osteocartilagineous femoral trochlea flap are reported according to the author's practice combined with an evaluation of these methods considering current literature.
RESULTS: Indications for the free vasscularised corticocancellous femoral trochlea flap include scaphoid nonunion with avascular proximal fragment combined with humpback deformity, previous operations, extensive bone defect, and long standing nonunion. The free vascularised osteocartilagineous medial trochlea flap may replace a destroyed proximal scaphoid pole. The literature reports only a few patients with healing rates between 80 and 100 %.
CONCLUSIONS: Both corticocancellous and osteocartilagineous free vascularised medial trochlea flap improve therapeutic options in treatment of difficult scaphoid nonunion. Until now only the results of a few patients have been published. Therefore, a final evaluation will be possible when long-term results in a reasonable number of patients are available.