After Vascularized Bone Flap (MFC / MFT)

A specialized reconstruction where a small piece of bone from the knee, with its own blood vessels, is transferred to rebuild the wrist. Recovery involves both the wrist and the knee donor site.

What was done

A small piece of bone was taken from the inner side of your knee with its own blood vessels attached, and then transferred to the wrist. The blood vessels on the bone were connected under the microscope to small blood vessels at the wrist, so the transferred bone arrives with a living blood supply. This is called a vascularized bone flap.

Depending on the problem being treated, one of two flaps was used:

Medial femoral condyle (MFC) flap — used to rebuild the scaphoid for non-unions in the waist or body of the bone, and for proximal pole non-unions that still have adequate cartilage.
Medial femoral trochlea (MFT) flap — used for proximal pole scaphoid non-unions with avascular necrosis and for Kienböck's disease (to rebuild the lunate). The MFT carries a small cartilage surface, which lets it replace not just bone but also a worn joint surface.

You have two surgical sites: one at the wrist and one on the inner side of the knee. Both need care during recovery.

The first 2 weeks

Wrist

The wrist is in a bulky dressing, often with a splint that keeps it at rest and protects the flap.
Keep the dressing clean and dry. Do not remove it.
Keep the hand elevated above the level of your heart as much as possible for the first 5 to 7 days.
Full finger motion from the first day is important — the fingers are not in the splint and should be moving all day long.
No nicotine in any form (cigarettes, vapes, patches, chewing tobacco). Nicotine constricts the small blood vessels that keep the bone flap alive; it can cause the entire reconstruction to fail. This starts before surgery and continues for at least 6 weeks after.
No caffeine in the first week (some surgeons ask for this; check with us about our specific recommendation).

Knee (donor site)

There is an incision on the inner side of the knee, covered with a dressing. Keep it clean and dry.
You can put weight on the leg as comfortable from the day of surgery. There are usually no weight-bearing restrictions.
Expect swelling and bruising that can extend down to the calf. Icing the knee (20 minutes on, 20 off) helps.
Elevate the leg on a pillow when sitting.
You may use crutches for comfort for the first few days if walking is painful.

2 weeks: wound checks and cast

Come in at 10 to 14 days for suture removal at both sites and a check of the wounds.
The wrist is typically placed in a short arm cast or a custom thumb spica for another 4 to 6 weeks to protect the healing reconstruction.
The knee incision is usually fully closed by 2 weeks and needs no further care beyond keeping it clean and out of direct sun.

6 to 8 weeks: imaging

X-rays and usually a CT scan are obtained to assess healing of the reconstruction. For scaphoid non-unions this is the first look at whether the bone has united; for Kienböck's, it confirms that the transferred bone is incorporating. If imaging is on track, the cast is changed to a removable brace and hand therapy begins.

Therapy and return to use

Hand therapy begins around 6 to 8 weeks, focusing first on wrist motion and then, gradually, on strength.
Knee: no formal therapy is usually needed. Normal walking is fine from the day of surgery. Running, squatting, and kneeling are held back until 6 weeks.
Full strength and unrestricted use of the wrist is reached around 4 to 6 months, sometimes longer for manual laborers and athletes.

Pain and expected symptoms

Pain is worst in the first 3 to 5 days at both sites, and improves steadily after that.
A dull ache at the knee, especially when climbing stairs or squatting, can persist for several months. It resolves with time.
A small patch of numbness on the inner side of the knee is common and usually permanent — a small cutaneous nerve passes through the surgical area.
Wrist swelling, stiffness, and a "pins and needles" feeling as the nerves wake up are normal in the first weeks.

Activity

Walking: right away.
Driving: once out of the cast and not on prescription pain medicine — usually 6 to 8 weeks.
Typing / desk work: in the cast, in moderation, within the first 1 to 2 weeks.
Return to light work: usually 2 to 4 weeks in a cast.
Return to heavy manual work: 4 to 6 months.
Return to contact sport: 6 months, after healing is confirmed.
Return to running: 6 weeks, starting with walking-jogging intervals.
Deep squatting and kneeling: 6 weeks for comfort; full tolerance improves over months.

Follow-up schedule

Wound check and suture removal at 10 to 14 days. Cast check and x-rays at 4 weeks. Imaging and transition to brace at 6 to 8 weeks. Therapy started. Follow-up at 3, 6, and 12 months.

Why the no-nicotine rule is absolute

The entire reason we use a vascularized bone flap is to deliver a piece of bone with its own living blood supply. Nicotine in any form makes the small blood vessels inside and around that bone constrict, which can cut off the flow and cause the reconstruction to fail. A failed flap cannot usually be salvaged. No cigarettes, vapes, patches, or chewing tobacco for at least 6 weeks before and 6 weeks after surgery. This is not a moral position — it is a biological one.

Call the office right away if

You have a fever over 101°F
Either incision is draining pus, is spreading red, or is very warm
Pain at the wrist or knee is worsening instead of improving after the first few days
Fingers coming out of the splint are blue, pale, or cold
Swelling and pain in the calf of the donor leg (possible blood clot)
Shortness of breath or chest pain (possible pulmonary embolism — call 911)

About scaphoid non-union · About Kienböck's disease · Cast & splint care

Questions?

Call your office location for non-urgent questions:

NYU Langone Laurelton · 646-501-4950
NYU Orthopedic, Woodside · 929-429-3222
NYU Orthopedic, Richmond Hill · 718-206-6923
Jamaica Hospital Ambulatory Care Center (ACC) · 718-301-0720

See our office contact information for addresses and fax numbers.