Strategies in Trauma and Limb Reconstruction

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VOLUME 8 , ISSUE 1 ( April, 2013 ) > List of Articles

Original Article

Cortical tibial osteoperiosteal flap technique to achieve bony bridge in transtibial amputation: experience in nine adult patients

Mauricio Leal Mongon, Felipe Alberto Piva, Sylvio Mistro Neto, Jose André Carvalho, William Dias Belangero, Bruno Livani

Keywords : Amputation, Surgical technique, Tibia, Fibula, Flap

Citation Information : Mongon ML, Piva FA, Neto SM, Carvalho JA, Belangero WD, Livani B. Cortical tibial osteoperiosteal flap technique to achieve bony bridge in transtibial amputation: experience in nine adult patients. 2013; 8 (1):37-42.

DOI: 10.1007/s11751-013-0152-0

License: CC BY-NC-SA 4.0

Published Online: 01-12-2016

Copyright Statement:  Copyright © 2013; The Author(s).


Amputation, especially of the lower limbs, is a surgical procedure that gives excellent results when conducted under the appropriate conditions. In 1949 Ertl developed a technique for transtibial osteomyoplastic amputation which restored the intraosseous pressure through canal obliteration and expanded the area of terminal support through a bony bridge between the fibula and distal tibia. The aim of this study was to investigate the effectiveness of a modification of the original Ertl's technique in which a cortical osteoperiosteal flap created from the tibia is used to form a bony bridge during transtibial amputation in adults. Nine patients underwent leg amputations with the cortical tibial osteoperiosteal flap technique for reconstruction of the stump. The average duration of follow-up was 30.8 (range, 18–41) months. The post-surgery examination included a clinical examination and radiography. A 6-min walk test (Enright in Respir Care 48(8):783–785, 2003) was performed in the 32nd week after amputation. At 24th week post-surgery, all patients had stumps that were painless and able to bear full weight through the end. The creation of a cortical osteoperiosteal flap from the tibia to the fibula during transtibial amputation is a safe and effective technique that provides a strong and painless terminal weight-bearing stump. This constitutes a useful option for young patients, athletes, and patients with high physical demands.

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