The bone-myoplastic amputation and reamputation below the knee

  • V. I. Shevchuk Scientific Research Institute of Invalid Rehabilitation on the base of National Pirogov Memorial Medical University
  • Yu. O. Bezsmertnyi Scientific Research Institute of Invalid Rehabilitation on the base of National Pirogov Memorial Medical University
  • H. V. Bezsmertna Scientific Research Institute of Invalid Rehabilitation on the base of National Pirogov Memorial Medical University
Keywords: amputation below the knee, bone plastic, muscle plastic

Abstract

         The analysis of 340 amputations and reamputations below the knee was carried out. In 206 cases (experimental group), osteomuscular plastic was performed with the closure of the medullary canal by a thin cortical plate, the formation of a synostosis between the truncated bones and muscle plasty with the fixation of the muscles to the bone and the graft. In the control group, traditional myoplasty was performed with the stitching of antagonist muscles under the bone saw (134 patients). The observation period is 2–10 years. Methods of investigation: clinical, radiological, CT, ultrasound, tonicometry, tensometry, measurement of intraosseous pressure, morphological. Closure of the medullary cavity led to the restoration of intraosseous pressure, a rapid (1–2 months) formation of the bone closure plate, the preservation of the shape and the structure of the bone stump. Bone synostosis prevented the ballot of the fibula. Fixation of muscles to the bone provided a good closure of the filings and the formation of a hardy muscle stump. The amputation stumps after bone-myoplastic amputations become durable, functional, painless and long lasting. Any of cases required a reamputation. In the control group, the formation of the osseous occlusal plate was violated in most of the observations, there was a resorption of the cortical bone, much more muscle was atrophy, there was a pain syndrome of varying intensity. In a number of cases reamputation or reconstructive operations were required.

Downloads

Download data is not yet available.

References

1. Bezsmertnij Yu. O. Lіkuvannya ta profіlaktika sindromu kuksi malogomіlkovoї kіstki // Lіk. sprava=Vracheb. delo. – 2006. – № 5–6. – S. 61–64.
2. Vasil'ev A. Yu., Egorova E. A., Vyklyuk M. V. Kliniko-luchevaya diagnostika izmenenij kul'ti bedra i goleni posle amputacij vsledstvie minno-vzryvnoj travmy // Med. vizualizaciya. – 2011. – № 1. – S. 107–116.
3. Vasil'ev A. Yu., Egorova E. A., Smyslyonova M. V. Luchevaya diagnostika izmenenij kul'tej nizhnih konechnostej pri protezirovanii // Klin. medicina. – 2013. – № 5. – S. 51–57.
4. Vojnovskij E. A., Pyl'nikov S. A., Kovalyov A. S. i dr. Rezul'taty amputacij nizhnih konechnostej v sovremennyh vooruzhennyh konfliktah. Bolezni i poroki kul'tej // Med. vestn. MVD. – 2015. – № 5. – S 10–14.
5. Shevchuk V. І., Bezsmertnij YU. O., Majko V. M. Kіstkova plastika pіd chas amputacіj і reamputacіj nizhn'oї kіncіvki // Ortopediya, travmatologiya i protezirovanie. – 2011. – № 1. – S. 47–54.
6. Bosse M. J., Morshed S., Reider L. et al. Transtibial Amputation Outcomes Study (TAOS): Comparing Transtibial Amputation With and Without a Tibiofibular Synostosis (Ertl) Procedure // J. Orthop. Trauma. – 2017. – Vol. 31, N 1. – Р. 63–69.
7. Kahle J. T., Highsmith M. J., Kenney J. et al. The effectiveness of the bone bridge transtibial amputation technique: A systematic review of high-quality evidence // Prosthet. Orthot. Int. – 2017. – Vol. 41, N 3. – P. 219–226.
8. Nijmeijer R., Voesten H. G. J. M., Geertzen J. H. B., Dijkstra P. U. Disarticulation of the knee: Analysis of an extended database on survival, wound healing, and ambulation // J. Vasc. Surg. – 2017. – Vol. 66, N 3. – P. 866–874.
9. Pavlov V., Bezsmertnyi Yu., Zlepko S., Bezsmertna H. The photonic device for integrated evaluation of collateral circulation of lower extremities in patients with local hypertensive-ischemic pain syndrome // Proc. of SPIE Vol. 10404 1040409-10. doi: 10.1117/12.2272324.
10. Preißler S., Htielemann D., Dietrich C. et al. Preliminary Evidence for Training-Induced Changes of Morphology and Phantom Limb Pain // Front Hum. Neurosci. – 2017. – N 11. – P. 319.
11. Tosun B., Selek O., Gok U., Tosun O. Medial gastrocnemius muscle flap for the reconstruction of unhealed amputation stumps // J. Wound. Care. – 2017. – Vol. 26, N 8. – P. 504–507.
12. Zhang Xin, Xu Yongming, Zhou Jin et al. Ultrasound-guided alcohol neurolysis and radiofrequency ablation of painful stump neuroma: effective treatments for post-amputation pain // J. Pain Res. – 2017. – N 10. – P. 295–302.

Abstract views: 100
PDF Downloads: 74
Published
2018-06-27
How to Cite
Shevchuk, V. I., Bezsmertnyi, Y. O., & Bezsmertna, H. V. (2018). The bone-myoplastic amputation and reamputation below the knee. Likarsʹka Sprava, (3-4), 132-140. https://doi.org/10.31640/3-4.2018(21)
Section
Guide lines for the practitioner