Versatile Application of the Medial Femoral Condyle Free Flap: A 10-year Experience

Background: Management of osseous nonunion presents a significant challenge to reconstructive surgeons. Conventional treatment options include rigid internal fixation with nonvascularised bone graft, local pedicled vascularized bone flap, and microvascular free bone flaps. The medial femoral condyle free flap (MFC-FF) is versatile, with reliable blood supply, good pedicle length, and ability to be harvested in various compositions. It has been well described in the literature for scaphoid reconstruction following recalcitrant proximal pole nonunion. Its application in other areas of the body has not been so well reported. Methods: Data were retrospectively collected using the hospital clinical applications system for all patients undergoing MFC-FF under the senior authors between 2014 and 2024. Preoperative, intraoperative, and postoperative data were collected. Results: Ten cases are included (7 upper limb, 2 lower limb, and 1 head and neck). Indications included recalcitrant osseous avascular nonunion, infected nonunion, and cortical bone defect secondary to trauma/other pathology. Patient ages ranged from 17 to 61 years. Mean time from injury to surgery was 54 months. Postoperative follow-up ranged from 2 to 54 months (average 6 mo). All patients demonstrated improvement in pain, restoration of function, and evidence of osseous union on x-ray. No donor site complications were reported. Conclusions: We demonstrate the MFC-FF to be a versatile flap that can successfully reconstruct a variety of osteochondral defects across the body, in an otherwise challenging cohort. We report good functional outcomes and a high rate of union, with limited donor site morbidity. It is a reliable flap, with a short learning curve for successful flap raise.