A free vascularized medial femoral trochlear (MFT) osteochondral flap, based on the descending genicular artery, is an effective surgical technique for reconstructing the scaphoid proximal pole. It provides excellent blood flow and sufficient structural strength, along with healthy hyaline cartilage and subchondral bone. We treated three male patients with advanced avascular necrosis of the scaphoid proximal pole using an MFT flap. The patients included two cases of Preiser disease and one case of scaphoid nonunion. The average patient age was 55 years (range, 34-70 years) . All patients underwent a dorsal approach with excision of the necrotic proximal pole, followed by MFT flap reconstruction. Clinical and radiological evaluations included assessment of bone union, visual analog scale (VAS) , grip strength, range of motion, QuickDASH scores, scapholunate angle (SLA) , and carpal height ratio (CHR) . Bone union was achieved in all cases at an average of 12 weeks (range, 11-13 weeks) . The VAS score improved from 63 to 8, grip strength increased from 56% to 76% of the contralateral side, and the QuickDASH functional scores improved from 16.2 to 4.9. The SLA improved from 84° to 73°, and the CHR improved from 0.48 to 0.49. The MFT flap provides reliable revascularization and structural reconstruction, offering an effective alternative to salvage procedures for advanced scaphoid avascular necrosis.
