OasisLMS

This paper describes the authors’ early experience using the medial femoral condyle (MFC) corticoperiosteal (and, when needed, chimeric osteocutaneous) free flap as a versatile option for complex midface/maxillofacial reconstruction when vascularized bone is preferred—particularly in previously irradiated or contaminated fields where nonvascularized grafts or implants may be higher risk. In a seven-patient case series (2018–2021) involving oncologic defects of the maxilla, orbit (orbital floor/medial wall), and nose, all flaps survived (with one arterial thrombosis takeback successfully salvaged), no donor-site complications were reported, and, over a mean 9.4-month follow-up, the authors observed no nonunions, hardware or bone extrusion, or osteoradionecrosis, with orbit reconstructions notably lacking postoperative diplopia or visual disturbance. The discussion emphasizes the flap’s reliable anatomy, pliability/contourability for small osseous or composite defects, potential for chimeric skin paddles or flow-through designs to address lining/coverage and pedicle-length limitations, and encourages microsurgeons to consider the MFC flap as part of the reconstructive armamentarium for select craniofacial defects.

Intended Audience

This educational activity is intended for all CME-related persons including plastic surgery practitioners, residents, and other healthcare professionals.

Learning Objectives

After viewing this course, the participant should be able to:

1. Identify appropriate indications for using a medial femoral condyle (MFC) corticoperiosteal flap in midface/maxillofacial reconstruction, particularly when vascularized bone is preferred in previously irradiated or contaminated fields.
2. Describe key anatomic considerations of the MFC flap—especially the role of the descending genicular artery as the most common pedicle and how cutaneous perforator variability affects planning for an osteocutaneous/chimeric design.
3. Outline the essential harvest steps for the MFC flap, including patient positioning, exposure, pedicle identification, and preservation of perforators when a skin paddle is needed.
4. Apply reconstructive strategy options for small osseous and composite craniofacial defects (maxilla, orbit, nose), including use of chimeric skin paddles or flow-through constructs to address lining/coverage needs and limited pedicle length.
5. Evaluate reported outcomes and complications from the presented case series (flap survival, takeback/salvage, donor-site morbidity, union and radiation-related complications) to inform risk–benefit counseling and postoperative expectations.

Tarek Ismail, MD, David E. Kurlander, MD, Z-Hye Lee, MD, Alexander Lunger, MD, John W. Shuck, MD, Rene D. Largo, MD, Edward I. Chang, MD

Editor-in-Chief: Kevin C. Chung, MD

Co-editor: Amy S. Colwell, MD

Pediatric/Craniofacial editor: Jessie A. Taylor, MD 

Seenu Susarla, MD, DMD, MPh; Solomon Lee, MD

• Systems-based Practice
• Medical Knowledge
• Practice-based Learning and Improvement

The American Society of Plastic Surgeons (ASPS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation
The American Society of Plastic Surgeons designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AMA PRA Category 1 Credit^TM: 1.0
Media:Journal Article
Release Date: 3/20/2026
Expiration Date: 3/20/2029*
Estimated time to complete this course: 1 hour
*Course access ends on course expiration date

Disclosure Policy
The American Society of Plastic Surgeons (ASPS) requires all faculty, authors, planners, reviewers, managers, staff and other individuals in a position to control or influence the content of an activity to disclose all relevant financial relationships or affiliations. All identified conflicts of interest must be resolved and the educational content thoroughly vetted by ASPS for fair balance, scientific objectivity and appropriateness of patient care recommendations. The ASPS also requires faculty/authors to disclose when off-label/unapproved uses of a product are discussed in a CME activity or included in related materials.

Disclaimer: All relevant financial relationships for planners, faculty, and others in control of content (either individually or as a group) are reviewed by the ASPS Continuing Education Committee and have been mitigated, if applicable. 

The following planners/faculty members/reviewers have the following disclosures:
Edward I. Chang, MD – Consultant – Novadaq, Ince and Musculo Transplant Foundation, Inc and Baxter Healthcare. 

The following planners and faculty members have no relevant financial relationships or affiliations to disclose:

Tarek Ismail, MD

David E. Kurlander, MD

Rene D. Largo, MD

Solomon Lee, MD

Z-Hye Lee, MD

Alexander Lunger, MD

John W. Shuck, MD

Seenu Susarla, MD, DMD, MPh

Recognition Statement

The Continuing Medical Education (CME) credits offered by this activity are enhanced by ASPS Learner Credit Reporting for learners who have opted into this reporting. Successful completion of this CME activity enables active American Board of Surgery (ABS) members the opportunity to earn credit toward the CME requirement of the ABS's Continuous Certification program when claimed within 30 days of completion of the activity.

Participants in ASPS-accredited education who want their CME credits reported to certifying and state licensing boards must opt-in to reporting and add their NPI as well as state license ID and/or collaborating board ID(s) before claiming credit.

Directly provided by the American Society of Plastic Surgeons® (ASPS®)