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

Authors

  • Francisco Soldado M.D., Ph.D.,

    Corresponding author
    1. Pediatric Hand Surgery and Microsurgery, Hospital da Luz/ Hospital Beatriz Angelo, ESSAUDE Lisbon, Lisboa, Portugal
    2. Paediatric Orthopaedic Surgery and Radiology Unit, Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca (VHIR), Spain
    • ES Saude Lisboa, Av. Lusíada 100, 1500-650 Lisboa, Portugal
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  • Sergi Barrera-Ochoa M.D.,

    1. Paediatric Orthopaedic Surgery and Radiology Unit, Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca (VHIR), Spain
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  • Cesar Garcia Fontecha M.D., Ph.D.,

    1. Paediatric Orthopaedic Surgery and Radiology Unit, Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca (VHIR), Spain
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  • Sleiman Haddad M.D.,

    1. Paediatric Orthopaedic Surgery and Radiology Unit, Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca (VHIR), Spain
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  • David Barastegui M.D.,

    1. Paediatric Orthopaedic Surgery and Radiology Unit, Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca (VHIR), Spain
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  • Ignasi Barber M.D.,

    1. Paediatric Orthopaedic Surgery and Radiology Unit, Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca (VHIR), Spain
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  • Paulo Rego M.D.

    1. Pediatric Hand Surgery and Microsurgery, Hospital da Luz/ Hospital Beatriz Angelo, ESSAUDE Lisbon, Lisboa, Portugal
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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. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013

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