Vascularized periosteal graft from the first metatarsal bone: A new technique to prevent collapse of osteonecrosis of the talus in children. A case report

Abstract

Several microsurgical techniques have been described for the treatment of osteonecrosis of the talus (ONT). Recently reported in children, vascularized periosteal grafts showed promising revascularizing properties. We report a novel technique using a pedicled periosteal graft from the first metatarsal bone to treat steroid-induced early Ficat-Arlet stage III ONT in an 11-year-old boy. The patient presented initial favorable clinical and radiological results which were maintained at 34 months during the last follow-up. Through this original technique, and basing on the powerful osteogenic and vasculogenic propreties of periosteal flaps, we could effectively induce bone revascularization and prevent further collapse of the talar dome.