Medial femoral condyle corticocancellous flap for treatment of scaphoid nonunion

Free vascularized corticocancellous flap from the medial femoral condyle based on the descending genicular artery was described by Sakai, and Doi et al., and separately by Masquelet in 1991 (Sakai et al., Plast Reconstr Surg 87:290-298, 1991; Masquelet, Plast Reconstr Surg 88:1106, 1991). Since then, the application of this free flap has broadened the surgeon’s armamentarium to successfully treat nonunions of the clavicle, tibia, humerus, mandible, and scaphoid (Friedrich et al. 7:45-54, 2012). The success of this flap has been attributed to its robust blood supply (Rogers and Gladstone. J Bone Joint Surg Am 32-A:4:867-874, 1950). Originally described as a small corticoperiosteal tubular bone flap, it has been frequently employed as a living patch to recalcitrant nonunions and necrosis of larger bones because it provides adequate living cells and growth factors. This chapter describes the use to the free corticocancellous bone flap for the reconstruction of scaphoid nonunion associated with avascular necrosis and humpback deformity. Indications, preoperative markings, surgical steps, postoperative care, complications, operative dictation, and suggested readings are included.