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

Author(s)

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

• Document type: Journal article
• Source: STRATEGIES IN TRAUMA AND LIMB RECONSTRUCTION; v. 8, n. 1, p. 6-pg., 2013-04-01.

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. (AU)

• FAPESP's process: 09/02089-3 - Immediate internal fixation with reamed interlocking nail and early soft tissue reconstruction of tibial open fractures
• Grantee: Bruno Livani
• Support Opportunities: Regular Research Grants