The medial femoral condyle (MFC) flap represents a valid source of thin and pliable sheet of corticoperiosteal tissue with or without cancellous bone [1, 2]. The highly osteogenic nature of the periosteum combined with its excellent vascularity after microvascular transfer achieves a high success rate in many scenarios. Most common indications for the MFC flap include bone nonunions [3–5] with or without segmental bone loss and total bone and cartilage reconstruction [6, 7]. Flap variations can incorporate also cancellous bone, muscle, tendon, cartilage, and/or skin.