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

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

doi:10.1007/s11751-013-0152-0

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.

Highlights

Amputation, especially of the lower limbs, can give excellent results when used for correct indications [1]
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

Summary

Introduction

Amputation, especially of the lower limbs, can give excellent results when used for correct indications [1]. Despite modern reconstruction techniques and replantation, the preservation of a severely traumatised lower limb or a limb that is affected by painful chronic osteomyelitis usually yields poorer functional results than amputation and prosthetic use [2]. Transtibial amputations result in excellent functional outcomes [3]. 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 by creating a bony bridge between the fibula and distal tibia [4]. The original technique involved the preparation of a periosteum cylinder that was extracted from the tibia with attached bone fragments, which promoted tibiofibular synostosis at the distal extremity of the amputation stump. Variations of the bony bridge have been described [6, 7]

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