A, Medial view of femur after elevation of vastus medialis. This exposure is much more extensive than that required for scaphoid reconstruction but is provided to demonstrate the vascular anatomy of the descending genicular artery (DGA) system. B, Dorsal approach to scaphoid nonunion after resection of proximal pole and nonunion site in preparation for reconstruction. Fingers are to left and forearm to right. Note generous resection and preservation of midcarpal articulating cartilage. C, Medial femoral trochlea (MFT) and planned portion of reconstructed proximal scaphoid. Portion of MFT and planned portion of reconstructed proximal scaphoid. Portion of MFT harvested to provide vascularized osteocartilaginous reconstruction of proximal scaphoid. A, descending geniculate artery; B, transverse branch; C, longitudinal branch; D, superomedial geniculate artery.