14 May 2017
Severe lower leg injury which required immediate below knee amputation due to the vascular compromise at the level of lower leg. Despite severe comminution and soft tissue defect, parts of the femur and thigh have been saved. There were other concomitant injuries but not life threatening.
Our aim is always to preserve the limb. If an amputation is required, we want to amputate as low as possible due to the increased level of energy consumption with higher level amputations.
After the below knee amputation and debridement was completed, spanning external fixator was applied together with cement spacer at the level of the femoral defect.
The discussion whether shouldn't we just proceed with an above knee amputation took place and the patient was presented with all known pros and cons. The patient decided to proceed with the limb reconstruction, in this case re-growing of his femur. At the moment we are estimating the defect in the range of 15cm, but will know more about it when the whole femur X-ray is taken. Estimated time to complete the treatment is 1 year.
22 May 2017
After stabilisation, repairing of the injuries we proceeded with internal fixation of the femur using AxSOS3 plate from Stryker on the basis of our previous positive experience with plate's endurance and stability.
AxSOS3 plate was used for the fixation after additional debridement of the bone - proximal and distal fragment up to the bleeding edges, or close to it. Cement spacer (Palacos Bone Cement) was used to fill the gap together with Stimulan beads with Vacomycin and Gentamycin. Wound was closed and the residual skin defect was grafted (mesh skin graft).
16 June 2017
So far going well. All wounds healed. No sign of infection. The defect length is around 20cm.
The knee joint is stiff and will be working on it.
08 July 2017
All set for bone transport. Because in young patients bone growth can be quite unexpected we X-rayed the femur before the surgery. As you can see on the X-rays below, there is a significant bone growth at the back of the femur.
I don't think this is as a result of the Masquelet technique. At least this is not what we see in majority of our patients. Bone cement and "pseudomembrane technique" are in my opinion not a substitute for a bone transport.
During the surgery we were able to confirm significant bone plate at the back of the thigh securely connected to the proximal and distal fragment.
01 August 2017
To my great surprise the new bone just continues to grow. Very unusual response but we were aware of the possibility. I personally don't have any significant experience and don't know what to expect in the future. Current strategy is "wait and see".
Wounds all healed and it looks that infection is very likely under control.