Vascularized Femoral Myo‐Periosteal Graft for Congenital Pseudarthrosis of the Tibia: A Case Report

ABSTRACT Pure vascularized periosteal transplants have been shown to be extremely effective at achieving rapid bone healing in children with biologically complex non‐union. Free tibial and fibular periosteal transplants are generally indicated when large periosteal flaps are necessary. We report using a vascularized femoral myo‐periosteal graft (VFMPG) to treat distal tibial osteotomy non‐union in a six‐year‐old boy with congenital pseudarthrosis of the tibia. The graft consisted of a 9 cm myo‐periosteal flap (after 50% of elastic retraction) that incorporated the vastus intermedius muscle and diaphyseal femoral periosteum nourished by the descending branch of the lateral circumflex femoral vessels. Plantaris medialis was used as a recipient vessel. Healing occurred 10 weeks after surgery. The patient resumed gait and sports activity without orthosis. No donor or recipient site complications occurred 17 months after surgery. Employing a VFMPG might be an alternative to other free or large vascularized periosteal flaps currently in use for complex pediatric non‐unions.