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).


Abstract

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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  1. Livani B, de Castro GF, Filho JR, Belangero WD, Ramos TM, Mongon M (2011) Pedicled sensate composite calcaneal flap to achieve full weight-bearing surface in midshaft leg amputations: case report. J Reconstr Microsurg 27(1):63-66
  2. Tekin L, Safaz Y, Göktepe AS, Yazýcýodlu K (2009) Comparison of quality of life and functionality in patients with traumatic unilateral below knee amputation and salvage surgery. Prosthet Orthot Int 33(1):17-24
  3. Ebrahimzadeh MH, Hariri S (2009) Long-term outcomes of unilateral transtibial amputations. Mil Med 174(6):593-597
  4. Mongon ML, Davitt M, Carvalho JA, Belangero WD, Livani B (2010) Transtibial amputation using the Ertl bony bridge technique. Eur Orthop Traumatol 1:21-24
  5. Okamoto AM, Guarniero R, Coelho RF, Coelho FF, Pedrinelli A (2000) The use of bone bridges in transtibial amputations. Rev Hosp Clin Fac Med Sao Paulo 55(4):121-128
  6. Pinto MA, Harris WW (2004) Fibular segment bone bridging in trans-tibial amputation. Prosthet Orthot Int 28(3):220-224
  7. Ng VY, Berlet GC (2011) Improving function in transtibial amputation: the distal tibiofibular bone-bridge with Arthrex Tightrope fixation. Am J Orthop 40(4):E57-E60
  8. Ertl J (1949) Uber amputationsstumpfe. Chirurg 20:218-224
  9. Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Jt Surg Am 58(4):453-458
  10. Gustilo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 24(8):742-746
  11. Enright PL (2003) The six-minute walk test. Respir Care 48(8):783-785
  12. Pinzur MS, Pinto MA, Saltzman M, Batista F, Gottschalk F, Juknelis D (2006) Health-related quality of life in patients with transtibial amputation and reconstruction with bone bridging of the distal tibia and fibula. Foot Ankle Int 27:907-912
  13. Harness N, Pinzur MS (2001) Health related quality of life in patients with dysvascular transtibial amputation. Clin Orthop Relat Res 383:204-207
  14. Pinzur MS, Beck J, Himes R, Callaci J (2008) Distal tibiofibular bone-bridging in transtibial amputation. J Bone Jt Surg Am 90(12):2682-2687
  15. Legro MW, Reiber GD, Smith DG, del Aguila M, Larsen J, Boone D (1998) Prosthesis evaluation questionnaire for persons with lower limb amputations: assessing prosthesis-related quality of life. Arch Phys Med Rehabil 79:931-938
  16. Gwinn DE, Keeling J, Froehner JW, McGuigan FX, Andersen R (2008) Perioperative differences between bone bridging and nonbone bridging transtibial amputations for wartime lower extremity trauma. Foot Ankle Int 29(8):787-793
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