The free vascularized bone graft from the medial femoral condyle, first reported by Sakai et al. in 1991, was initially used as a periosteal bone graft for recalcitrant nonunion of the upper limb but was later reported to be useful for scaphoid nonunion. It is now widely used for various types of nonunion and avascular necrosis. Recently, a study reported that the cartilage morphology of the medial femoral trochlea resembles the proximal articular surface of the scaphoid and can be raised as a vascularized osteochondral graft. We have actively applied medial femoral condyle bone grafting to various cases of nonunion, including avascular necrosis of the scaphoid, since 2014, and performed cartilage reconstruction of the proximal part of the scaphoid and metacarpal head reconstruction by osteochondral grafting from the medial femoral trochlea since 2019. Herein, we report the key points and risks in the elevation of the vascularized bone and osteochondral graft from the medial femoral epicondyle and trochlea, and the characteristics of vascular anatomy of the DGA.
