Advanced Techniques in Limb Reconstruction Surgery

Because of fresh advances in surgical ideas and implant expertise it really is now attainable to accomplish limb reconstruction in sufferers with quite a number congenital, posttraumatic, and postinfection pathologies. This booklet is a transparent, useful advisor to the state of the art surgeries hired in limb reconstruction for various stipulations. It contains specific descriptions of the options themselves, observed through various important drawings and pictures. Pearls and pitfalls are highlighted, and thorough recommendation can be supplied on symptoms, preoperative making plans, and postoperative follow-up. The editors have rigorously chosen the participants in response to their services, and lots of of the authors have been themselves answerable for constructing the recommendations that they describe.

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3 Femoral and Tibial Deformity Correction MNSA = 130° (124−136°) MPFA = 84° (80−89°) aLDFA = 81° (79−83°) JLCA (0−2°) MPTA = 87° (85−90°) LDTA = 89° (86−92°) Fig. 6 Normal values of deformity planning analysis of the lower extremities • Prophylactic antibiotherapy is initiated (firstgeneration cephalosporin, cephamezine 4 × 1 g IV for 3 days). 1 Exposure/Incision Osteotomies in the long bones can be executed percutaneously through limited incisions, by either the Gigli saw technique or the multiple drill hole technique (Paley and Tetsworth 1991).

The level of lengthening osteotomy and the length of the IM nail are chosen to ensure that at least 8 cm of the nail lies above the distraction gap at the end of the lengthening procedure (Fig. 27) (Paley et al. 1997a, b). • The deformity is corrected acutely using an LRS-type external fixator (Orthofix, 57 b Bussolengo, Italy) or an EBI Monorail Fixation System (Biomet, Parsippany, NJ, USA) (Fig. 28). – Using swivel clamps, small amounts of adjustment (up to 10°) are possible in the frontal plane.

If the deformity is at the distal femoral metaphysis, retrograde IM nail insertion should be performed through the intercondylar notch. • The diameter and size of the IM nail should be determined based on the scaled AP and lateral x-rays of the affected bone segment(s). • Digital or paper tracing should be performed to simulate the surgery and to determine the provisional and final position of the bone segment, according to the following factors (Figs. 5): – The location of the extra, custom-made hole(s) on the IM nail should be determined.

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