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The management of high-energy trauma to the foot often requires multiple tissues reconstructive procedures with various technical options. The authors report the case of a patient presenting an extensive defect of the medioplantar region of the right foot involving an almost complete (90%) medial cuneiform bone loss. A deferred operation with saphenous cross-leg flap and interposition of a cement spacer was first performed. Reconstruction of the bone defect with corticocancellous iliac bone graft was subsequently carried out at two months post-trauma. At four months follow-up, the bone and soft tissues healing were good. At 24 months follow-up, the patient could return to normal professional and sports activities. The saphenous cross-leg flap has proven to be a reliable reconstructive procedure. The use of the modified Masquelet technique ensured an anatomical reconstruction and a satisfying final functional outcome.

Characterizing osteochondral lesions of the talus has enabled the strategies of surgical management to be better specified. The main technical problem is one of access for arthroscopy instruments to posteromedial lesions. A range of techniques and approaches has been described in ankle arthroscopy in general, and a transmalleolar approach provides reliable and efficient access in these cases. It is frequently used for transchondral drilling, but also enables satisfactory implant positioning in autologous osteochondral mosaicplasty procedures. We report our technique and results on five cases with a minimum 1.2 years' follow-up.

Level IV.

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