Definition of Bone Transport from an Orthoplastic Perspective

Abstract

Reconstruction of traumatic composite bone and soft tissue loss (TCBSTL) employs several approaches among which is the bone transport (BT). In this procedure a healthy bone segment is mobilized by means of an external fixator to bridge a bone gap. Mobilization of the bone segment entails advancement of the overlying soft tissue envelop altogether. Between the year 2000 and 2017 the authors have treated 150 cases of TBSTL using distraction histogenesis and external skeletal fixation in all cases. The procedure was performed in two modes, in the first group the transport was performed gradually by distraction-compression of the osteotomy and bone defect sites respectively. In the second group, the procedure was performed by acute shortening and re-lengthening (ASRL) technique. Skin grafts(STSG)were used in six cases (4%) and iliac crest bone graft(ICBG) in 42 cases (28%). No free vascularized tissue grafts were used in any case. No internal fixation was attempted in any case. A few problems have been met with during gradual bone transport, and were manageable without effect on the treatment course or final outcome. Based on our observations in this series, BT was defined as “Bone transport is an instrumented advancement of a local vascularized osteomyocutaneous flap to bridge bone and soft tissue defect either gradual or acute.” When perceived as an osteomyocutaneous flap, bone transport extends the umbrella of the reconstruction ladder to include cases where other procedures could not be safely employed. Bone transport, either gradual or acute, is a powerful tool in the armamentarium of Orthoplastic limb reconstruction.