The vascular anatomy of the periosteum of the distal femur provides the opportunity to harvest unicortical bone flaps and small convex osteochondral flaps based on noncritical regional vascular pedicles. The anatomy, versatility, and applications of these flaps have been an area of innovation in reconstructive plastic surgery over the past 30 years. There are four flaps that are relevant to this region. The corticocancellous medial femoral condyle (MFC) flap is the most widely used, being harvested from the thin medial face of the distal femur based on the descending geniculate artery system. Based on the same pedicle, the osteochondral medial femoral trochlea (MFT) flap provides bone and cartilage from the proximal-most convex surface of the femoral trochlea that articulates with the patella. The lateral femoral condyle (LFC) corticocancellous flap is harvested from the lateral face of the distal femur based on the superolateral geniculate artery system. The same vascular system may be used to harvest the lateral femoral trochlea (LFT) flap, which provides an osteochondral segment from the lateral side of the femur with a different convex morphology than the MFT flap. The corticocancellous MFC and LFC flaps are used to treat small intercalary long bone nonunions, as onlay corticoperiosteal flaps for atrophic nonunions without significant bone loss, or as small corticocancellous flaps for scaphoid waist nonunions. The osteochondral MFT and LFT flaps are used to reconstruct small convex articular defects, with particular focus in the treatment of extremely small fragmented scaphoid proximal pole nonunions, or in advanced Kienbock’s disease demonstrating significant lunate fragmentation and collapse.