Anatomy Overview:

• Increasingly popular flap for small to medium sized bony defects with indications for vascularized bone
• Used predominantly for bony reconstruction of the hand and wrist but has been described for a variety of unique bony defects of the upper and lower extremities.
• Reliable flap, consistent arterial anatomy and pedicle size, minimal donor site morbidity
• Arterial Supply:
  • Most common – Descending Genicular Artery
    • Originates from the SFA, runs just deep or lateral to the adductor magnus tendon
    • Has three terminal branches – Articular branch (periosteum and cartilage), muscular branch (vastus medialis) and saphenous branch (overlying skin/subcutaneous tissue)
• • Alternatively – Superomedial Genicular Artery
    • In some cases, may be the dominant pedicle to the MFC flap
    • Originates from popliteal artery, crosses deep to the adductor magnus tendon to anastomose with the articular branches of the DGA
• Venous Drainage is typically from the paired VCs that run with EITHER the DGA or SGA

Topics Covered:

• General thoughts on the MFC flap, is it a flap you commonly use? What do you use it for in your practice?
• What do you think are some of the advantages vs. other vascularized bone flaps (fibula, iliac crest)
  • Advantages vs. NONvascularized bone grafts vs. pedicled bone grafts
• How do you like to do your markings? Skin paddle vs. without.
• Dissection:
  • Initial incision and dissection landmarks
  • Pedicle identification
  • Osteotomies
  • If you need to base your flap off of the SGA at what point do you make this decision and how does your approach change?
• How large of a bone flap/skin paddle can you take?
• Inset (if using for scaphoid):
  • How do you fixate your flap – K wire, screw, etc?
• Medial Trochlear Flap
  • Advantages vs. disadvantages?
• Flap monitoring?
  • Do you monitor your MFCs?
• Donor Site Morbidity:
  • Any issues with ambulation, knee instability, etc?